Home Birth: Why This Doctor Would Still Choose One

Nearly 30 years ago I gave birth to my first baby at home, followed by three more children via three more home births in the ensuing decade. My four births were beautiful, meaningful, empowering events that supported my smooth transition into natural mothering. Admittedly, this was long before I was a physician.

In fact, I was a home birth midwife.

Having home births – and being a midwife – were congruent with how I lived: as close to nature in my lifestyle choices as possible. During labor I felt the most comfortable being in my home, walking on the golf course behind my house, squatting during contractions, and eating & drinking freely to maintain my energy and stamina. It was where I felt the safest and could take the path of least resistance to how I wanted to birth. I also knew I was making an educated decision based on extensive research into the history of birth in many cultures, and the evidence for obstetric practices at the time.

But what about now that I am a Yale-trained physician and a family doctor with a specialty in obstetrics? Would I still have my babies at home? Come take a journey with me…

Home Birth is More Than a Romantic Choice: It’s About Mom’s and Baby’s Health and Safety

Where we choose to have our babies actually has to do with more than simply personal preference, spiritual beliefs, and romantic notions. It’s a public health and safety issue.

Just skimming the surface, we know that planned home births lead to substantially fewer unnecessary cesarean sections than do hospital births. We also know that prenatal care and birth attendance provided by a midwife are more likely to help pregnancy and birth stay on a natural trajectory, and are much less likely to result in unnecessary interventions of any type.

There are very real health reasons for women to consider birthing at home. These include mom’s safety, baby’s safety, and the economic sustainability of our health care system.

What’s The Big Deal About Cesareans, Anyway?

The national cesarean section rate is a shocking national average of 34%. At some major teaching hospitals in the US, including one of the ones in which I trained, the rate exceeded 40%. In fact, interviewing at some of these institutions when considering a residency in obstetrics, I was assured that there would be no shortage of cesareans for me to do!

Yet the World Health Organization states that C-section rates in an average, healthy population should never need to exceed 14%! When medically necessary, the benefits outweigh the risks and become acceptable. Unfortunately, most cesareans done in the U.S. are UNNECESSARY, making the risks unacceptable.

Clearly the US obstetrics system missed the memo on appropriate birth intervention rates!

There are not only immediate risks to the mother; we know that babies born by cesarean section miss out on the benefits of exposure to the vaginal flora that they’d otherwise come in contact with if born vaginally – and this lack of exposure can predispose a baby to disrupted gut flora and significant consequent health problems. Additionally, babies born by cesarean get a dose of antibiotics before birth via mom’s system, adding to the double hit on gut flora!

Birth by cesarean can make it more difficult for mom to breastfeed successfully because of physical discomfort. And let’s not forget that it is major abdominal surgery with much higher risks of harm for mom than with natural, vaginal birth.

Hospital Birth & Loss of Autonomy

During the years when I was having my own babies at home, people would comment that I must be incredibly brave to birth my babies at home. My response was always the same:

I wasn’t brave at all – I was simply terrified of having my babies in the hospital!

By the mid 1980s the cesarean section rate was escalating and had reached what then seemed to be an astronomical 18%. In retrospect I wouldn’t have believed it could get to where it is now, and the American Congress of Obstetricians and Gynecologists (ACOG) has stated that the rate will likely reach 50% before hitting a plateau!

At that time the episiotomy rate was approximately 99% and the epidural anesthesia rate was not far behind. Every woman was required to be strapped to a monitor and to have an IV line placed “in case of emergency.” One OB actually told me that he considered all pregnant women “disasters waiting to happen.”

I was just having a baby, not an emergency appendectomy! I didn’t want all of these potentially dangerous interventions for something that was almost always natural and safe. It sort of reminds me of those commercials for a medication for something benign like a foot fungus. You know, you’ve got a little athlete’s foot so treat it with something that can cause “heart problems, coma, and death.” It’s just overkill for something that’s usually just not that big a deal in a healthy person.

As a midwife I’d observed the loss of autonomy that too often occurred when a woman set foot in the hospital – the transformation that occurred with the ritual of shedding her “real person” clothes in favor of the hospital johnnie, and with it the shift of going from being an independent, capable woman into “a patient” – which culturally equates with being dependent, helpless, and sick – qualities that are a far cry from feeling empowered and strong.

Now, having been through obstetrics training I can honestly say that I’d feel even more concerned about having my baby in the hospital – unless absolutely medically necessary.

Aside from the astronomical cesarean section rates, numerous other complications are occurring in record numbers. One of these is chorioamnionitis, an infection in the “bag” that holds the water around the baby, leading both mom and baby to need antibiotics during labor and after birth – sometimes leading to separation of mom and baby after birth so the newborn can be observed in the nursery. This infection is due almost exclusively to bacteria acquired in the hospital, and is commonly transmitted to the mother when excessive vaginal examinations are performed to assess labor progress.

Women are expected to labor according to the “Friedman curve,” an obsolete measure of how many centimeters she should dilate per hour, and are given medications to stimulate labor when things are not going according to that archaic and inaccurate plan. Pitocin, the most commonly used medication, can cause the baby to go into distress, and in a domino effect, culminate in a cesarean section. This is just a small glimpse of what can – and generally does – go wrong in the hospital setting, leading to the high and inappropriate level of interventions we have in birth.

What should be used as lifesaving techniques, applied routinely, have become dangerous interventions for mom and baby. Yet we are told this is what we are supposed to do for the sake and safety of our babies. Because we are good moms, and trust the medical establishment to be looking out for our best interests and acting on the basis of scientific evidence, we acquiesce – sometimes against our better judgment, and sometimes only to discover later that we were bamboozled into the agenda of the profit-driven behemoth called the health care system.

Obstetric Evidence Is Reliable Only 30% of the Time

Are obstetrics practices reliable?

Well, the 99% episiotomy rates have declined dramatically in the wake of ACOG admitting that what they previously professed to be necessary was actually harmful. At the same time, rates of most other birth interventions from inductions to vacuum extractions have escalated.

We are just now seeing a leveling off of the preterm birth rate in the US. Until recently, inductions and scheduled cesareans have been a leading culprit in the high incidence of preterm births in the US. The costs of the high rates of preterm babies to individuals and society has been so overwhelming that mandated changes in hospital policies now prohibit cesarean sections prior to 39 weeks of pregnancy unless absolutely medically necessary for mother or baby. Again, what was previously deemed safe by ACOG has been recognized to be harmful.

Do we have a theme here?

Indeed, a report by ACOG itself acknowledged that only about 30% of the obstetrics practices in the US are based on reliable medical evidence. Thirty percent have poor evidence, and the rest, well, mezza mezza, as my grandmother would have said.

Let’s take the external fetal monitor, for example. Used ubiquitously in US hospitals, this annoying machine with its two tight belly belts, one to measure the amplitude of contractions, the other to measure baby’s heart beat during labor, not only keeps laboring moms virtually tethered to the hospital bed, it dramatically increases the rates of unnecessary cesareans, without improving any meaningful outcomes for mom or baby. This is well documented in the annals of the obstetrics and family medicine professions, yet its use persists. Why? It’s one of a limited number of forms of evidence that can protect obstetricians and hospitals in the event of a lawsuit.

Now that I am a physician many women ask me if I would still have my babies at home.

My answer is unequivocally: “Absolutely.”

While you might say, “Well that’s easy for you to say since you’re long past your childbearing years” and don’t have to make that choice, the proof is in the pudding in that I was the midwife to my granddaughter, born at home, to my public health specialist son and pediatrician daughter-in-law – after I’d already become an MD! While I had in no way suggested, encouraged, or even broached the topic of home birth with my Harvard-trained daughter-in-law, who by the way, also has an MPH from Harvard, her own experiences during the course of prenatal care led her to approach me. She’d concluded that home birth would be the safest option for her and her baby.

There are Some Terrific Docs But…

Now don’t get me wrong, there are a lot of terrific doctors doing a spectacular job attending births in hospitals. In fact, growing numbers (though still not the majority) of OBs are women who would like to see birth practices be democratized and evidence-based. And many women do experience empowered, beautiful, natural births in the hospital. It’s just a bit of a roulette, happening against the odds that fewer than 60% of women will even birth vaginally if in the hospital.

The problem does not lie solely or even primarily with individual doctors. Hospital risk management teams, insurers, and legal committees ultimately determine how your doctor is allowed to practice. And a lot of it comes down to preventing litigation against doctors and hospitals – and has absolutely nothing to do with your best interest.

Residency training instills the practice of “defensive medicine” early on. Many obstetricians exit residency not knowing what a truly natural birth even looks like, and have come to believe that birth is a dangerous event that must be contained and controlled. I have even heard some obstetrics’ residents describe women who choose to birth at home as irresponsible, and even lunatics.

On the other hand, growing numbers of obstetricians have become so disenchanted with and stressed by the medico-legal environment of their profession that they have stopped attending births and instead are focusing solely on gynecology. Recently I’ve even had several OBs contact me to learn how they might be able to practice in a more “holistic” woman-centered way. They want to love and trust birth again!

To Be Fair, The Home Birth Model is Not Perfect, Either

Lest you think I am on a doctor-bashing rampage here, please let me remind you, I am a physician. I’ve seen birth from unique vantage points. I’ve been through conventional medical training and am part of “the doctor club.” And I’m also a midwife. I really have no agenda other than to see women receive the best possible, most respectful care available, and to see us be able to receive that in the setting in which we feel safest giving birth. I do believe this can happen in hospitals. I recognize the many women prefer to birth in hospitals, and some must for medical reasons. These women still deserve to retain their autonomy, and to have unnecessary interventions minimized and safe and respectful practices maximized. Women can be partners in their care, not subjects of it.

As a midwife with 30 years of experience in the birth community, I will also readily admit that there are quite a few not so great home birth midwives contributing to not so great birth outcomes. In fact, in reaction to the problems found in medicalized birth settings, there’s a bit of a midwife ‘wild west’ out there – anyone can get “the calling,” attend some births, and call herself a midwife. Caveat emptor! It’s not black and white. A poorly planned home birth or a less than competent midwife (or physician, though most home births are attended by midwives), in the rare event of a complication, can be disastrous. There’s no romanticization about that from me – I’ve been in the birth trenches for 3 decades and I know some firsthand horror stories from the mouths of the moms and midwives themselves!

Can The Birth Climate Change?

A healthy, respectful atmosphere could exist in which the choice of birth place is depolarized and women are supported in making the choice that is best for them and their babies. In fact, ACOG and the American Association of Pediatrics have recommended that this be the case amongst their members. Honest informed consent, with accurate disclosure of the best available evidence to pregnant and laboring mothers could occur. Midwives and OBs alike should honestly disclose their beliefs, practices, competing demands, experience levels, and outcomes. Women can be respected as intelligent clients capable of making smart choices, rather than being treated as helpless patients.

Critical self-reflection and communication with a common goal of providing optimal maternity (and neonatal) care in all settings is key — and achievable — if we can remove emotional hyperbole and actually listen to the concerns of all involved. I believe there is more common ground than difference.

Birth can be seen as a healthy, natural, normal experience – unless evidence-based medical indications demonstrate otherwise, and in those cases, the least amount of intervention necessary could be judiciously provided. And romantics aside — medical interventions are sometimes needed even in healthy moms who have eaten all the right foods and thought positive thoughts!

Healthy relationships could be established between the medical community and the midwifery community, and women could be supported in their choice to have babies at home, while being welcomed seamlessly into a medical setting should problems arise necessitating that care be transferred to a medical team. Better yet, there could be continuity of care in which there is no separation between birth models – where the only care offered to women is compassionate, respectful, and centered on the woman’s wishes, needs, beliefs, and best interests.

In fact, this is the type of care I have tried to provide my midwifery clients and my medical patients alike – and I know it is entirely possible! All choices and options can be respected. And birth itself can be respected as a natural process that offers women a powerful opportunity for empowerment.

It is my hope that your birth experiences leave you feeling empowered and whole, regardless of where or how you bring your baby into the world. I would love to hear your thoughts on this important topic! Please leave comments in the section below. I will do my best to respond to as many as possible. And please talk with each other – there is so much this community of women can share to help support and empower each other!

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Susannah

I worked as a labor nurse in the US before moving abroad. I worked at a great hospital with skilled nursing staff and doctors. The general practices, policies and mindset about birthing were not in line with what I wanted for me or my babies, when the time came. I have since had 2 home births with a very skilled midwife here in Europe. I felt the risk of causing a problem in the hospital was far greater than the possability of a natural complication of pregnancy. Niether home birth nor hospital birth is for everyone, a woman needs to be able to trust those around her when laboring and deserves that her best interests (in this case her and her babies health and wellbeing) are accounted for. Great post, I used your pregnancy book the last time and found it very helpful. Thank you for the work you continue to do.

Jen

Great article! I am a mom of 8, having birthed all of mine in the hospital. I wish I could have had homebirths, but my husband was totally against it in the beginning. By the time the fourth or fifth one came along and he had changed his mind, I had had a stroke due to a DVT following one of the pregnancies...the result of hospital interventions! Now no midwives will agree to take me as a patient, even though I have had only 1 C-section and 7 healthy, natural vaginal births.
Is there any option for a mom who gets turned away by the midwives? I am not interested in an unassisted birth, but I know I don't want to go back to the hospital!!

aviva

Emily

What if you have the factor V leiden mutation with no history of DVT or complication? I felt obligated to birth in a hospital last time but would love to know I had the option for a home birth next time.
Thank you for your lovely article! It is so good to read from someone who has your range of expertise and experience.

aviva

Oh, I know it's hard when one has a sort of unavoidable health conflict such as a coag disorder!
It's really important to work with a maternal fetal medicine specialist and get their opinion. And if you're on aspirin or anticoagulants to manage, then home birth should not be on the table -- hospital is safest in that case.
Best wishes! Aviva

Mercedes

I had my first child in the hospital and was forced at 9 cm, due to hospital policy, to have a cesarean. It has been almost 6 years and I am due in 5 days. Thankfully I found a midwife practice who was not only willing to attend my home birth, but encourages VBACS as a healthy option for many women, and acknowledges that VBACs are a much safer option than repeat cesarians. It took me until my 29th week of pregnancy to find them because in my state, CPMs are not licensed so they're kind of underground. For me, I had come to the conclusion that an unassisted home birth would actually be safer for me than going to the hospital where 90% of women who have had a cesarian are forced to have repeat cesarians with no other options. So thankfully, I won't have to do that but there are women out there who will deliver VBACs, especially considering that you had 7 vaginal births! Obviously, everything works!! Just be persistent and ask around. The complications related to repeat cesarians are significantly worse and more likely to occur than those related to VBACs- statistically speaking.

Catherina

Thank You Aviva!
It's wonderful to have honest, current and trustworthy information to share with the expectant Mammas I teach prenatal yoga to. I will be referring women to your site in the future!
With Gratitude,
C

Alma

Thank you for this informative piece! Though im not planning for my 3rd and final little bundle anytime soon, I want to gather as much research as possible regarding homebirth. My first birth was with an OB. They're a team of 5 and the original OB I saw didn't deliver my baby. I bled a lot and the OB who delivered had a hard time stitching me up and they even did an xray to see if by accident they left a gauze in my uterus...???...I didn't get to nurse my baby right away (about 4hrs later to be exact). I wasn't too happy with the experience but I had a vaginal birth. My second was with the same hospital and I switched from the same OB to a midwife at around 34wks pregnancy because baby was breech and OB said C-section if baby doesn't turn. By that time the hospital became baby-friendly. I got induced at 40+8. Though an induction, it was fast and I had skin-to-skin with my lil guy. Almost one year later anf nursing strong. I really want a homebirth or go to a birth center. It's reassuring to know that the ACOG says to wait at least to 42wks before discussing induction. I have long pregnancies (of course to my luck haha). I was 21 when I got pregnant with my firstborn and my 17yr old sister told me about midwives and I made the bold move with my 2nd baby at 24yrs old. I have learned so much. I hope women become more educated and informed the way i have become because i was so naive in a lot of things. Thank you again for this!!!!!!!

Terrie

Dr Aviva, Thank you so much for sharing this. I am a CNM with 14yr of hosp experience and just opened a homebirth practice last fall. You have eloquently and succinctly presented the facts and have expressed my own heart. I will share this post with many. Your ideas will also help me in some presentations I am doing about homebirth in the near future. Thank you. A huge challenge in my endeavor is medical backup. While I know physicians here from my hosp practice days, I do not have a backup. MDs feel restrained by hosp contracts, malpractice "wont cover us if we back up home birth" etc. In my state I dont have prescriptive rights either for the same reason (MI). Challenges, but still doable. I want to be here for my women. They are so thankful for the option, as there is no other homebirth midwife in the area. Thank you again. I am encouraged.

Trudi Dido

Aviva , It's been so long ago that I hesitate to even talk about it . My three sons born in 1973,4 and 6 were all c -sections.. in White Plains hospital. The first was a transverse lie and could not be turned(?) . so the next two were scheduled c -sections . I've always wondered why it all happened. and sorry for my inability to have had the easy birth I had planned. The first child was oxygen deprived due to swallowing meconium and died three weeks later at Cornel NICU. and the second was taken two weeks early because of the early decision made from his sonagram that said I didn't know when I had conceived(!).both my husband and I have "big heads" and so of course our kids did too. though they seem "normal " when the got here.. Both sons are doing fine some 30+ years later. so maybe I'm just digging up old trash. but I've never gotten to have a discussion about it before so thanks for giving me the courage to do it now. The third child I just said to my OB. Do you want to know when I conceived or do you want me to make up a story so he can stay put as long as possible.?,
Sincerely ,Trudi

Sarah

Trudi,
I'm sorry to hear that your first son died, and that your births didn't go how you had planned and hoped for.
I wanted to let you know that there is an organization called ICAN (International Cesarean Awareness Network) that has chapters all over the world. Even though your births were 30+ years ago, you would be welcome. It's never too late to get support! You can find more information at ican-online.org.

Kathy Boyer

Trudy,
I hope that posting has been a relief/release for you. Your experiences are exactly what Aviva is talking about here: how the medical model makes women feel helpless, lost, and confused about why things happened the way they did. We often make decisions with little or no information because doctors just poo-poo our desire for more information. They have their way and they are afraid to let women make their own choices. In the future when you go to the doctor for other health concerns, I hope you can feel empowered to demand more information, fully understand why doctors are making their suggestions, and reach out for second opinions or say 'no' to the lame ones. I'm sorry that your baby passed away. That must have left you feeling very vulnerable for the next two. But, I bet you are strong, and can offer advice to other moms who lose their babies. <3

Shona Boisvert

As a childbirth educator and birth doula (and home-birthed baby 35 years ago), I am regularly disheartened by the horror-show image people have in their minds about birth. It's no wonder, really.
I was delighted to see this article in my inbox this morning, though. How timely. How uplifting. Your unique perspective as both a midwife and obstetrician, and the credibility that affords you, is invaluable to our struggle to reform birth practices. I'm curious how many other physicians in the U.S. are also midwives. Does anyone know? What a specialty!
Here in British Columbia, Canada, our Midwives Association of B.C. has just put a call out for an increase in access to midwifery services in the province (in other words, more funding from our public health care system). We are SO LUCKY to have midwifery care covered under our Medical Services Plan.
Here is to wishing my southerly sisters much success in your efforts to educate and empower birthing women and their families. Thank you for your passion and dedication.

Suzanne Brown

Aviva, thank you for your thoughtful and thought provoking articles.
My two babies were born in the early '70 when, as I remember, an episiotomy was recommended as the best thing to do. My husband and I knew very little about the birthing process. We attended a hospital sponsored lecture with other parents-to-be given by a group of obstetricians/gynecologists practicing at the hospital. I should have said no thanks after the crude remark made by one of the doctors about being better after the procedure! I am grateful to read that they are no longer done on all mothers.
I have seen studies on woman shortly after the births that included an episiotomy. I have been wondering for a while if one of the results of having had an episiotomy might be stress urinary incontinence as this group of mothers age?

aviva

Yes, it can -- but so can prolonged pushing (i.e. hours) without one, so it's not a totally straightforward episiotomy causes and natural birth prevents. But yes, the last stitch on an episiotomy used to be called "the husband's knot" and many crude comments have been made about it!
There's a great set of pelvic floor exercises on the Mayo Clinic website -- free -- for incontinence and exercises have a high cure rate! Good luck and thank you for writing!!! Aviva

Sal

I work at the University of Otago Medical School in New Zealand. We have a study blown up and posted on the wall at the O&G clinic showing increased pelvic floor dysfunction (including incontinence) in parous women who had episiotomies as compared to women who delivered without episiotomies (vaginally and by cs) and to nulliparous women. What you're describing is accepted as fact in other parts of the world!

Anna Marie DeRosier

Aviva, my daughter is 40 and not yet pregnant. Consequently, a child birth for her will be when she is in her 40's. DOES AGE have any consideration in home birthing which she wants to do. Also she has an RH factor to consider. Would you be willing to write me on these matters....
THANKKKKKKK YOUUUUU SOOO MUCH... Anna Marie DeRosier

aviva

If she is otherwise healthy, then not necessarily at all! Rhogam can be given by a home birth midwife or at a doctor's office -- just needs to be within 72 hours of the birth. Glad to write more about this in the future!
Enjoy being a grandma when the time comes. It's the best!!!!

Jenna Prince-Farmer

Aviva, thanks for sharing. I purchased your book "The Natural Pregnancy" a few years ago and read it in hopes I could have a holistic approach to pregnancy as much as possible. I am healthy and have always taken care of myself. I am pregnant now and have had many complications including many subchorionic hemorrhages and just last Tuesday my water broke at 24 weeks and 2 days. I'm in the hospital staying positive that we can make it to 34 weeks. I have never had to stay in one room for so long! As you can imagine, this was not my plan for my first pregnancy, but am hoping for the best possible outcome. I admire you and appreciate your wonderful articles. Thanks for all you do! I hope to have a doctor like you some day. Jenna

jenna prince-farmer

Jaymie

Cedar Cat

Great and informative article. Empowering women to make informed choices. Rock on, Aviva!
Another great education about home birth and the skyrocketing c-section rate (50% in my county on Long Island) is the documentary film "The Business of Being Born", by Ricki Lake. I liked the film because it gives us images of the home births, actual videos! When you see these beautiful births, at home, with the loving arms of the husband supporting mother, it is touching beyond words. And then we see the medical birth scenario, and it's jarring.
Giving birth is natural and women are made to do this on their own terms. Pregnancy and childbirth are not diseases to be treated. Thank you for celebrating the miraculous, creative power of women!

Brooke

Sallie

Hello Aviva,
I had my first baby at a birth center in south Georgia, and it was a wonderful experience. My second was born at home in Michigan, and now I'm planning another home birth for the third that is coming in May. I plan on sharing this article!
Incidentally, I met you a few times when I was a kid. My mother's best friend Miranda was like a second mom to me, and she knew you....Her influence on my views about natural living have been fundamental to me.
Thank you for all the work you do for women!
Sallie

Anna Young

Thank you for the article Aviva, like always. I am currently 40 weeks+3 days, my first birth, and GBS+. I am now beginning to become very nervous about our choice to birth in the hospital. Prior to my learning my GBS status, I felt calm and planned to labor at home as long as possible, that way help relieve the possibility of unnecessary inductions or interference with pitocin from the hospital. But now with my GBS status, and my daily coming closer to an induction date, my fears are beginning to rise in my lack of control and greater inability to have a natural birth. I know being GBS positive in itself is not a huge concern and can easily be dealt with antibiotics, however, if my water were to open, I'm expected to go immediately to the hospital, even if contractions and dilations have not occurred due to the risk for my baby. Which leads me to think...Pitocin will then be forced on me? Which then leads my fears to an epidural and likely csection. If we choose to have a second, I know I will be birthing either at home or a birthing center. The amount of stress that I am expericing now is not a good way to begin prelabor.

Brooke

Hi Anna - just wanted to tell you to stay strong and calm :-) Stay connected with your baby through this whole process and everything will be fine...no matter what happens. You may also consider getting a doula. This way you know for sure you have someone on your side advocating for you in the hospital. Just a thought... Good luck with your pregnancy and birth!

Friend

Hi Anna,
I just wanted to say that I am currently 37 weeks myself and just learned about the GBS thing because a friend of mine tested positive (I have not been tested myself) and is trying to understand her options. I talked with my midwife about it and she said there is new research coming out about it. All of us have some levels, it's just a matter of how high they are when they happen to test you, and that number could easily go back to down to a negative test result by the time you go into labor. A much more accurate thing is to have a quick test after going into labor, and even in that case, antibiotics may not be needed. It is more important in that case to watch the baby closely for the first few days and then give antibiotics immediately if they show signs of toxic levels. But she said the outcomes of taking antibiotics during labor especially if the positive test was more than a couple days ago, are questionable in their helpfulness and may even be harmful, as giving a newborn antibiotics is not in their best interest unless really necessary. Hope this helps put your mind more at ease and you can do more research yourself. Outdated practices sometimes take a long time to change and it's hard for docs and hospitals to allow risks that could become a lawsuit for them, so they always are gunna want to do the antibiotics thing.... Good luck strong mama!

Anon

Anna,
I hope you will research as much as possible GBS. I have tested positive before and delivered in a hospital, believing everything they told me and was stressed. My midwife, with my 5th baby gave me the choice of even having the test. I opted out. I had a wonderful, successful home birth and have no idea if I was positive or negative for GBS. There are other options. I hope you can still have the homebirth you desire.

Tessa

I was in the same position as you when my water broke. Just remember, it's your body!! Ultimately the hospital can't force anything on you. They will try to make it sound like you don't have a choice, like you have to take the pitocin but it's your choice! I actually ended up having acupuncture done at the hospital in order to induce instead of pitocin. It worked like a charm! I went from 4 cm to babe in arms in 8 hours after acupuncture.

Crystal

Hi Anna :) I was GBS+ with my 2nd and 3rd. With my 2nd, I did the antibiotics. With my 3rd, I labored at home naturally, washing myself with a diluted solution of Hibiclens, an asceptic wash used in hospitals and available at drug stores over the counter. This from what my midwife told me is common practice in Europe to treat GBS during labor, rather than antibiotics. For us, the risks associated with newborn infection, however slight, were not worth it to me to leave it untreated. So we did the Hibiclens rinse every 2 hours during my labor and I felt at peace doing so, and he was fine. Just a suggestion to look into it. But I'm no medical professional :)

itslikemusic

This is one of the best things I've read in a long time. It's so great, because I am pregnant now, with my third baby... we are choosing to birth at home, after two hospital births- my first was pitocin-ladden within an hour of my water breaking naturally, and my second was an unnecessary induction at 38 weeks gestation. Both with epidurals. I have never been more excited and empowered to be able to have this baby in a loving, caring, and comfortable place, surrounded by my family and my children. I'm not a condition, or being treated like a naive little girl who doesn't know what she's doing. I am so appreciative of you for writing this, and I will be showing this to my mother, who is fearful of my home birth. Thank you Aviva. So many thanks!

avivatf

I like how you framed this in a non-confrontational way. I was living in a musty basement apartment when my daughter was born, so even though I liked the concept of homebirth, it was definitely not for me at the time. I gave birth with a supportive CNM in one of the "crunchiest" hospitals in the country without any interventions or meds.
The one thing that I didn't like about the birth is that I had to wait for what seemed like an eternity but was really probably only 10 minutes before the nurses and pediatrician "allowed" me to hold my own baby (she was fine --they were weighing her, taking her apgar, cleaning her, etc) It seems like such a trivial thing compared to what other women experience, but I will always remember pleading desperately to hold her and being ignored as my first experience of motherhood. My husband (who was eventually called in from a different room) saw her before I did! I now realize that for that birth I should have gone with a birth center. I hope to have future children in my own home.

Valerie

Aviva, I got your Natural Pregnancy and Natural Health after Birth books with my first pregnancy. I delivered at a military hospital, and my provider (who just happened to come on duty halfway through my very long labor!) was a male (!) midwife, father of 7, certified lactation consultant, and he was great. Long story short, it was a very long labor, with a long phase II (5 hours), and even though the female OB wanted to talk surgery (threatened me with it, if I didn't get the baby out in 30 mins), I asked to be allowed to continue to labor because I knew if given enough time, it would happen. My midwife was extremely supportive and essentially went toe to toe with the OB in the hallway, to protect my decision. My daughter was born healthy, with no adverse affects from the long labor. I did have some interventions, including an epidural after about 38 hours and they did break my water, and we did have to be on IV antibiotics for a couple of days. She is exceptionally healthy and intelligent. During my second pregnancy I was diagnosed with lichen sclerosus and we moved at about 5.5 months gestation to a different state. I was lucky enough to find a CNM with lots of experience and a great approach to birth, as well as many years' experience nursing in emergency and ICU scenarios prior to midwifery, who agreed to take me on at 6.5 months and finish my prenatal care and be there for the delivery, which was in water and was very short, relaxing and amazingly empowering. Now I am 32 weeks with my third, and I am over 40 so I have been told I am going to be induced at 39 weeks and I have to have twice weekly monitoring to ensure I do not become a late-term stillbirth statistic. The midwife situation is tougher here, it is not as easy to get one to come to where I live, and if there is an emergency, the potential to have trouble getting to a hospital is very high due to unbelievable traffic. I have toured the hospital, and it is baby friendly and very nice, but it is still a hospital. I feel very torn, because I don't want to put myself and the baby in a situation where we will have too much unnecessary intervention, and I also don't want to put us in a situation where we would be in trouble if something happened, and I have looked at the risks for women my age and there is actually a significant increase in the risk of late-term stillbirth in mothers my age. How would I feel if I did a home birth and something went wrong? I feel like I am damned if I do and damned if I don't. So, I am using herbs as indicated in your books, I am doing energy medicine as described in Donna Eden's book Energy Medicine for Women (for pregnancy), and I am taking great care of myself. I am working on Mindful Birthing, and I am reading Natural Hospital Birth. My husband and I are prepping the van for a scenario where we'd have to pull over if traffic is bad and handle it in the back. I got myself a birthing TENS unit that I used in my home birth that I found very helpful. I am going over labor-specific accupressure points, massage, different positions, and things my husband can do to help me, such as massage down my spine during contractions, press on my hips during contractions, remind me to change positions every 5 contractions, push on my knees while I am seated, etc, which I learned during my home birth. I am going to do everything I can to make this birth as positive and healthy as I can, armed with knowledge from my past experiences, your books and the books of others, and my very strong and supportive spouse. I am holding a vision for this birth and I am hopeful that the providers at this hospital will at least listen, because I have been told by many women the staff are great. I wish we all had the option to homebirth, and I would do it in a second if we were closer to a hospital and I knew the midwife would have support and privileges, but at this point, I am going to make the most and best of a hospital birth and try to be there for as short a time as possible. Thank you for your work, it has changed the lives of so many and has helped me in so many ways, so many times. I've passed your books on as gifts to more people than I can count! Namaste.

Allison

Aviva,
As a CNM (and a student of yours in your herbalist course) I work in a freestanding birth center. Our collaborating hospital is a tertiary care, medical center. Our collaborators are Family Medicine docs, usually, but we have a very collegial relationship with the MFMs as well. Thanks for bringing this discussion to your blog especially in light of the Manastats data just being released.

Joan

The beautiful empowered choice to birth at home, or at least on one's own terms with one's chosen caregiver is a freedom all women deserve. In Delaware at the moment, it is a felony offense for direct-entry midwives to attend homebirths. Midwives caught doing so go to trial and are slapped with huge fines. CNMs practicing in hospitals are often prevented from practicing their full midwifery skillset due to hierarchical hospital politics and liability. In a number of other states, as well, homebirth midwives are losing their OB allies to the fear-based policies set by hospitals' insurance companies. Birthing mamas and their families in these states are left with the option of hospital birth (and all its associated pitfalls) or unassisted homebirth (which is currently still legal). Mamas in states with a vibrant functional midwifery model of care, rejoice! And, please stand with those of us laboring to change laws, minds, & hearts in states such as DE, where this basic human right has become criminalized. We DE mamas would love to hear how families in other states with prohibitive birth legislation are making homebirth work (especially those of us who are pregnant)!!

karen webster

Joan

Hi, Karen! :) I have found a lot of empathy, so far not anyone who can commit to being with me on the day of. I'm still holding space for a reliable, experienced birth assistant with which to partner. And collecting supplies & info to make this work unassisted, if need be. Do you have time for a phone date this week, dear mama?

Donna

Depending how close you live, could you go across the border? I had both my sons at a birthing center in MD. I'm originally from DE, but moved to MD...I did not know that about DE and am very upset to hear about it.

SA

I have no children and no desire to have children; however, a friend of mine posted this article on Facebook and I found it an interesting read because I know several woman who have had water births at home and at birthing centers. For those of you in DE, I thought I would mention that there is a birth center in Wilmington. One of my friends gave birth there 6.5 years ago and she still raves about the center. If she has another child, I imagine she'll have it there. She also maintains a strong support unit of women who gave birth at the center around the same time. Best of luck to you.

Adrienne Gaha-Morris

I have three girls and I have had three very different birthing experiences. My first was a Cesarean (medically required, apparently), my second was a VBAC in a private hospital with the most alternative Ob I could find, but there was still intervention galore. My final birth was a glorious home birth with a Doula, husband, 3 friends and 2 girls. If I were having any more kids, which I am not, I know which option I'd be doing again! And what's more I'd probably be doing a free birth because I am so confident in my bodies abilities, and women have been giving birth for thousands of years.
I am planning on becoming a HB doula once the littlest has grown a bit too.

Amanda Fath

Hello Aviva,
Thank you for your insightful article. I am 6mths along with baby #2, my first I had in a hospital as I will with my second. I live in Canada & have acces to a wonderful clinic that operates out of a small hospital that specializes in low risk maternity care. You see a rotation of doctors & midwives throughout your pregnancy so it may seem like a whirlwind but it was great experience for me because you get lots of different insight & everyone is very warm & caring. Because they only do low risk they have special emphasis on no interference. C sections are avoided at all costs unless absolutely medically necessary & they will not induce you until at least 10 days after your due date & then if everything seems fine you can choose to wait longer. They offer water births, encourage walking & stair climbing during labour, they have many different props to use while in labour squat bars, exercise balls etc. there is no limit to the people allowed to attend & you can eat & drink freely. They encourage a drug free birthing process & continue to encourage you to tough through it during labour. My experience in that hospital was wonderful, they do not take your baby away after, you get to hold he/she immediately after & only when they weigh & measure do they take them & they are still right beside you in the room. They encourage breast feeding as soon as possible & have lactation consultants on hand to help if needed. You sleep with your baby right beside you in a bassinet or with you in the bed if you want. They are as unobtrusive as possible only interrupting if necessary during the important bonding hours right after labour & you get to stay for as long as you need to. I wish every hospital could follow their example they truly understand that birth is a beautiful natural process.

Jamie

Kate

I had an absolutely magnificent homebirth 14 months ago - I also did it because it seemed the most natural and the thought of being in hospital seemed wrong (I wasn't sick!). My wee guy danced into this world and we're still dancing! I wouldn't do it any other way. My family initially thought I was bonkers but I knew what was best and I was right! Unless you've got some pre-existing condition homebirth all the way!

Holly

I have a chronic illness, cystic fibrosis, and when I was pregnant with my daughter in 2001-02 I started out my care with a wonderful family practitioner. Due to a false high GTT I was transferred to a high risk practice, but received lass than optimal care. I was on Medicaid at the time and was treated very poorly because of it. I was not respected as a person, nor was my husband. We read, studied & attended Bradley Childbirth classes. We wanted to do everything possible to give me the best chance at being healthy throughout the pregnancy and birth and to give our daughter the best chance of being born healthy and mature. Even though I was very healthy and was having no complications and had a history of no blood sugar issues, and few pulmonary issues we were not allowed to have any say in planning our birth. We sought out a midwife and researched the laws to ensure that it was legal for me to have my baby out of hospital. Our chosen midwife was very experienced and had good physician back up in case of the need for transfer prior to or during birth. We lived only 5 minutes from the hospital and there was a fire station with EMS just two blocks away.
With our research done, we felt confident that I could birth safely and healthy at home. I was not having periods when I became pregnant, so we didn't know our conception date. Because of this we eschewed encouragement from the hospital doctors to induce when I went past the due date they'd assigned me.
I went into labor at 1pm on April 23, 2002. I have several hours of easy early labor during which I went grocery shopping, cooked, did laundry, and ate lightly. I labored for a few more hours with more intense contractions requiring my focus. Then, I labored through transition so smoothly that only my husband knew that is where I was. I had no internal exams during any of this because my bag of waters was leaky and we wanted to avoid any possible contamination. Our midwife checked my temperature, blood pressure, oxygen saturation (because of my CF) and our baby's heart rate intermittently throughout the latter part of labor and I continued to eat lightly and drink.
When the urge to push became irrestistable, the midwife checked to make sure I was completely dilated and effaced and would not incur injury by beginning to push. With one push my water broke and after 25 minutes of pushing, we found we had a lovely daughter. She had quite a bit of vernix and was only 7lbs 14 oz. We were very thankful we had not induced earlier or she would most likely have been premature. Because of the thick mucus in my vaginal tract, she required extra suctioning and oxygen to help her get started breathing, but our midwife was calm and prepared. We didn't cut our daughter's cord until it had stopped pulsing and we are certain that this helped her to recover from her hypoxia and prevented her from having complications.
Because of my experience, I encourage other mothers not to rule out natural birth or homebirth simply because they have pre-existing health issues, but to evaluate their situation with the help of a skilled birth attendant to see what is the best option for them. I also encourage these mothers to think critically about what their unique body needs in order for them to have the best possible chance at a healthy birth and to fight for those things. For me, doing without pain relief was a vote for my lungs and eating and drinking throughout labor was a vote for my strength, stamina and ability to recover. The ability to move around and choose positions and to birth upright helped me preserve my strength and maximize my lung capacity.
Today, our daughter is 11 years old and one of the healthiest children I am blessed to know. She is truly lovely and I wouldn't change anything about how she came into the world or how hard I had to fight for it. She is also our only child and because of that I am very thankful that I didn't let intimidation get me to make choices that I didn't believe were in our best interest. There is no redo button on your birth. You have to make choices you can live with for the rest of your (and your child's) life.
Thank you, Aviva, for your article.

Louise

Hi Aviva…
Your article re home births brought back memories of my own birthing experiences from over 30 years ago. My first child was born in a hospital at the insistence of his dad…a terrible experience for me. I wanted a natural birth & got anything but. I received a Pitocin drip and had my precious baby pulled from me with forceps because, according to the nurse, I was the doctor’s 3rd delivery that day & he wanted to go home to his family. In the process, he performed an episiotomy that ‘extended’ into my rectal sphincter. I was in pain for months & never did regain much sensation in the area, permanently diminishing sexual pleasure. The experience got even worse as they took my baby to the nursery insisting I couldn’t breast feed him until they gave him a bottle of sugar water to make sure he could swallow. I did manage to save my son from circumcision. I had specifically told everyone he was not to be circumcised but they were going to do it anyway. I intervened just in time.
My 2nd & 3rd children were born at home-both wonderful experiences. Funny, we were recently discussing at work where our children were born. I piped up that 2 of my kiddos were born at home. OMG…the silence, followed by comments such as, “Well, you were just lucky that something awful didn’t happen-that was a foolish thing you did”, etc, etc. I am a RN & these comments were from my colleagues-other RNs. I really wanted to ask them exactly how they thought that humanity replicated itself without OB/GYN interventions prior to the 20th Century, but, I know when to pick my battles. One comment from another nurse was that babies born at home are at much higher risk for brain damage (SO NOT TRUE!). OK, I had to respond to her about that one…I reminded her that my daughter just completed her PhD in biology & both sons are Systems Engineers at OHSU in Portland, Oregon. I told her I felt pretty confident that they didn’t sustain brain damage during birth.
If I had it to do over, I would opt for home birth in a heartbeat. Although it was not my step-daughter’s wishes, I am hoping my daughter or perhaps some daughters-in-law will choose homebirth. I simply cannot see bringing a precious new babe into the world in an environment designed to care for people who have significant illness or who are dying. Birth should be a celebration, not a medical procedure with a CPT code.
Bless you, Aviva…
Louise

Hilary

I too had two wonderful homebirth experiences. My first, I had planned for a birthing center, but being that I was 40 weeks and 6 days, it was brought to our attention that it was time to "get the baby out". While in the hospital, my husband decided that if were to have more babies, we were doing it at home. My hospital midwife was wonderful; it was the process of the hospital that was the problem for us. I value the medical knowledge when needed, but in our society we are taught that our bodies can't do what they were made to do. Fear is such a powerful tool. I wouldn't change my birth experiences of my 3 living children for the world. I unfortunately did have to return to the hospital for my third pregnancy when I carried stillbirth twins at almost 7 months. It turned out to be a beautiful experience with my homebirth midwife there as my doula and another patient hospital midwife. Go midwives!

Kay

I was so happy to have a midwife with my second child, it was so much better and easier, just because of the support. No unessesary IV in my arm, no awkward monitor strapped to me, I was free to move around my room and I was never alone. I was trusted to go to the bathroom when I wanted to or whatever, not like the first time when they insisted I hold on to my bowel movement because "it's actually the baby" when I knew it was actually a whole lot of poop that all came out when they finally let me push. With my midwives when I was pushing, one midwife coached me and kept me focused while the other worked down below making sure everything was good, and they were so kind to me and calm, I felt safe and trusted them. My baby stayed in the same room as me the whole time afterwards as well, until we were ready to go home, which was only a few hours later. =) They helped me help my baby latch on to breastfeed, and visited my home two times afterwards and assisted me again. I love it! Now i'm having my third and if it is anything similar to my second, I will be so happy. (even though I didn't get drugs!)

Adrian McFarlane

Hi Aviva,
I am the Husband of a Midwife and a full time Stay-At-Home-Dad SAHD (just trying to impress ya)! I always try to read and stay up to date on and stay knowledgeable of my wife's profession I also read everything she posts or FB's. I see a lot of comments here and I apologize if this question has been answered already, but I was wondering what made you change professions from Midwifery at an MD? feel free to email me your answer if you get around to it.
Thanks, Adrian.

aviva

To have more influence on how things get done in the medical world, to have a deeper knowledge of general medicine so I could take care of the mommas and babies before and beyond birth, and to be someone on the inside so that when women needed medical answers they could get them from someone they trust -- these are also the values I hope to bring to my blogs, etc. :)

Mary W

I absolutely loved this. I did a homebirth 1year ago and it was my first baby. I watched a video of a c-sec and became terrified of the hospital. That was my ultimate fear. I didn't fear being at home with my midwife who is fully competent and amazing. I cannot wait to do it again one day. I also fear that I might get addicted to birth. Seriously.

Teagan

Pamela

Dr. Aviva,
My first time pregnant daughter sent me your writing and I am so happy she did. Your comments are a complete reflection of my own birthing history. I had 4 home births from 1979 - 1989 after even having a hydatiform mole and being put on "high risk". I had to do my own research to discover that I did not have a cancerous tumor but that it was caused by herpes (I believe). I was also a lay midwife at the time and I used to tell people the exact same thing - that I was "terrified of having a hospital birth" with all of it's ridiculous interventions that just lead to complications. I find that so many uninformed parents are so blindly all-trusting in the Hospital model and that the myth of "irresponsible home birth" is still as strong as it ever was. Thank you for helping to explain what is really going on and for your strong support of birthing at home with a qualified midwife and birth team. The one thing I would like to add to your discussion from a personal feeling of having been there and done that- I always believed that the empowerment gained from "feeling the baby emerge" as opposed to being deadened by an epidural was one of the strongest moments of my life as a woman and the consequent joy I felt when going from the unbearable pain of labor and pushing to the bonding with the new miracle of life that i FELT come out of me was something that as a birthing mother should NOT BE MISSED. Thank you so much for all you are doing. I feel blessed to have had 4 wonderful children this way!

Kimmy R

Amanda

This is such a great article! I had both my babies at the birth center at ucsd and had amazing experiences both times. I was attended by nurses and midwives who totally understood my needs without me having to explain anything. My husband was very fearful of a home birth so this was the best compromise and it worked out really well. It proved to me that a hospital setting actually can facilitate a wonderful birth experience. Knowing that there are physicians like you in the world gives me hope that more women will have the opportunity to give birth without unnecessary interventions. I think women need to hear this point of view from doctors like you to understand the value of natural birth. You rock!

angela

Thank you for such a wonderful article, Aviva! I find this article very valuable considering your unique perspective as both a midwife and physician. I am pregnant with my second child and really hope a home birth is a possibility for me. Due to the troubles encountered with my last pregnancy I am worried that it is not an option for me. However, the more I read on home births, the more I realize that perhaps I have been unnecesarily scared into thinking this way. My first baby was born 10 lbs 12.5 ozs and I was 41.5 weeks pregnant. I went into the hospital to be induced on a Sunday and didn't have my baby until Wednesday. Tuesday morning the doctor broke my water and I was eventually fully dilated Wednesday morning and I pushed for about two hours. At this point the doctor told me I was putting the baby at risk because I hadn't made any progress in the last half hour and strongly recommended that I have a c-section. I was in tears at the decision because I was trying my absolute hardest to have him naturally and knew the benefits of a natural birth; but of course I didn't want to put my baby at risk due to my strong desire for a natural birth (which is how i felt after the doctor told me a c-section was the best choice for me). Not to mention that throughout this process, I was constantly monitored and rarely able to get up, unable to eat or drink and was given ELEVEN bags of fluid through IV. I came home weighing the same as what I weighed upon entering the hospital because of all of the fluids. My experience was far from being personal or relaxed and unfortunately my husband was deployed to Afghanistan during the birth which made decision-making hard and if I didn't make a decision quickly it seemed that it was made for me by a nurse. I felt taken advantage of. Needless to say, I am very determined to have a better experience this time around!
Later I was told that it wasn't very likely I would be able to have a natural birth if I decided to get pregnant again since my baby was so large and generally the birth weight increases with each consecutive pregnancy. So my question to you is, do my circumstances preclude me from the possibility of having a home birth? If not, what other factors should I consider in this decision? I'm afraid that being in a hospital I will be pressured to have a c-section when it may not be necessary. Yet, I am not a doctor and I don't fully know the risks associated with trying to naturally give birth to a large baby so I am seeking out as much advice as I can get on the subject. Thank you!

aviva

Hi Angela
Thank you for sharing your story.
It sounds like you were strong-armed into interventions that you may not have needed, but one thing I try not to do is second guess other physicians' observations if I haven't seen the records and wasn't there -- it's hard to know what their concerns were from my shoes. VBAC can be a great option, and many states even allow midwives to do these at home. But there are also many wonderful midwives and doctors who can help you in the hospital. I can tell you that your previous experience does not automatically predict a repeat of that experience! I would interview a number of practitioners for hospital births and see if you can find someone who is really empathetic and ask what their VBAC rates truly are. Another cesarean might not be necessary -- but to prevent an unnecessary one you'll have to be educated, confident, and have a good team to support you because it's so easy to also get mentally psyched into it. Hope this helps! Aviva

Owen

Hello,
We had a home birth for our first baby in the US. My wife was terrified by the idea of a hospital birth and a C-section (Maryland has a record high rate). It turned out to be a very difficult birth and we had insufficient follow-up.
Our second baby was born in Scotland. The system here is a good example of a close to ideal system. The Birthing Centre is attached to the hospital, but its entirely run by the midwives. The Doctors don't get involved unless there are complications (our doctor stopped by for 5 minutes to say hello, and afterwords to meet the baby). Apparently their C-section rate is about 1%. The least invasive approach is taken first and women are not held to a rigid schedule. When I told the midwife I was a herbalist and that we were going to use some herbs she was completely accepting. They even had a birthing pool, so my daughter was born in the water. Following the birth they send someone to your house every day for the first few days then space out the visits when you're ready - these continue for about 2 weeks. This includes professionals health workers trained in feeding issues and lactation.
I'm looking forward to a system in the US that doesn't polarize the subject into "sides," as this doesn't create the most effective, safe, natural, cost-effective, and of course experientially ideal situation for women giving birth along with their families.

The Computer Ate My Nym

aviva

Hi "Nym"
Given your bolds I assume this is a challenge as much as a question. It is well documented in the ACOG white papers and Green Journal that numerous cesareans are unnecessary. For example, to name just 3 of the most common obstetrics interventions, it is well known that inaccurate fetal monitor tracings lead to an increased risk of cesareans (aka unnecessary), that inductions in the setting of a low Bishop's score increase cesareans, and epidurals which prolong second stage of labor, increase them. A recent NYT article also demonstrated an association between increased income and cesarean. All of this is readily available in the public domain. ACOG is a medical association that represents a professional body and under recent leadership has somewhat better at practice self- reflection. As a member of the medical profession, I am kept apprised regularly of changes in practice and policy -- the overuse of cesarean sections is not a speculative matter nor just a reaction from the left anymore -- it is a medical profession issue that is being looked at long and hard. And yes, of course, there are many necessary cesareans, and sometimes gray areas where the mom and doctor must make a tough decision on which side of caution to err -- the natural or the surgical. I've been there -- it's not easy. I'm grateful that women have options! Best, Aviva

Brooke

Andrea MacLeod

I'm living in Canada and I believe the practice up here is a bit more in favour of women and how much autonomy they are able to retain. However, the midwife practice, especially in my province is less then optimal. The city I live in, with about 250.000 people, has only 4.5 midwife positions. The midwifery program is government funded and you can't just be a midwife (which I am fine with). Getting a midwife is extremely difficult and on average they have to turn 10 to 30 women away. Yet, they will not increase funding. Basically, I am denied the choice of home birth or hospital birth.
However, my OB GYN is very in favour of natural birth and we have discussed in length with her of what we would like to do. She will sign our birth plan and we hope she will be present at our birth. I believe the most important thing for women is to be informed, to know what procedures exist and how they can influence the birth, baby and mother. Equipped with such knowledge they should be able to take matters into their own hands and stand up to doctors who unnecessarily want to do things because "it's the norm". Moral support by a partner is also of great importance.
Last but not least, one should also be prepared for changes during birth. While we are planning on a natural birth with no interventions, we are aware that interventions might be necessary due to unforeseen circumstances. Should that occur and the health of my baby or myself is in jeopardy, I will not cling to my natural birth plan but listen to what the doctors have to say and decide on the best path.

Emily Kallio

Dear Aviva,
Thank you so much for this post, and for continuing to spread accurate information about home-birth. I feel immensely grateful to the wonderful midwives who supported me in birthing my two daughters at home. I truly hope that the medical model can move towards less intervention and trusting women's individual bodies more. Birth is such an amazing journey!
Blessings and thanks again for the work that you do,
Emily

Amanda

I am currently 30 wks with my second child. My first was born in 2003 via C-section due to no progression. I want to have a v-back with this baby but my doctor says I am not a good candidate because my daughter was 41 wks and 8lb 6oz. I only dialiated to a 2 with her after 16 hours. I had to have a section because "my water had been broken too long". Do you find it feasible for me to vbac?

aviva

Hi Amanda,
It's hard to know whether you personally area good candidate for a vbac, but it is great option for many women who had a low horizontal incision with their previous births.
Best wishes!
Aviva

Pauline Renard

Stephanie

Thank you for this article I totally loved all of the information. I delivered my baby at a birthing center and it was the most amazing experience of my life. You are so right when you said that it is empowering to have a baby naturally. I loved everything about my birth story and I LOVED the amazing feeling when I gave birth to my daughter I felt like I was super woman. I will continue to birth with a midwife, that is if I can manage to get pregnant again. I have a very hard time getting pregnant and I pray everyday that I can have another sweet baby. Thank you for this article it was amazing!!

Kathy Boyer

Planned Home birth is a very safe option for most women. The recent MANA Stats Project results are in! Planned home birth has so few interventions, great breastfeeding results, a low cesarean section rate, and few emergencies. Check out the study! http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full

Katie

This is an edited version of the one I already posted. Please dismiss the previous version and post this one if you could. Greatly appreciated.
Thank you so much for taking your time out to write this. As a young mother, giving birth at 21 years of age I was incredibly unprepared for the birth experience. I genuinely did not understand fully how flawed our birth system was. I began to get into a lot of Ina May Gaskin reading and joined numerous face book groups on natural minded birth. My eyes were opened to the absolute beauty, empowerment and awe of natural childbirth of which I had failed to see in my pre-pregnancy days. I knew that is what I wanted, truly natural and that I would get that. I made my birth plan after extensive research, reading and classes. Unfortunately, the 40 week appointment with my OB who previously was supportive of natural child labor turned things upside down for me. I had slightly elevated blood pressure and slight protein in my urine. I was diagnosed with pregnancy toxemia, of which I do not feel comfortable still with that diagnosis. I was rushed to the hospital, when I was supposed to be birthing at a birth center and induced with Pitocin. Things were a whirl wind of absolute shit from that point on. Everything was just wrong. I was not permitted food or drink, nor was I permitted to move much out of my bed. I was strapped to a blood pressure cuff, an intravenous catheter where I was hooked to fluids and pitocin administration as well as the two ungodly electronic fetal monitors around my abdomen. I can honestly say that later on in my birth I was on the verge of ripping those awful things off and throwing them at someone. I was constantly having random women come into my room telling me to position myself a certain way so that their useless monitors could pick up on their useless information. I was permitted a 10 minute shower only, which proved to be extremely beneficial for natural analgesic, but unfortunately as I said was forced to get out within 10 minutes of entrance. From that point on things went even worse because I realized how good the shower felt, yet they would not permit me back inside. I realized that I wanted to birth MY way, do as my body was telling me and I was NOT permitted because of these random women's orders. I became incredibly negative and wanted all of the strange people out of my room and to stop touching me. My water was broken in the middle of one of my many vaginal examinations. I was asked if I wanted it broken, but in the midst of an ungodly contraction while lying on my back was incapable of answering, so it was just done without consent. Things got rough and I do mean incredibly rough. I was in tears and at one point I was yelling at a lady "NO!" when she told me she just needed to readjust my monitors again. I was losing it. This is the point that I wanted to throw the monitors! I wanted to get out of the nightmare, but I could not. I felt violated. There was absolutely no empowerment nor was there any beauty. I felt like a science experiment, hooked up to countless contraptions. I felt like a prisoner being held somewhere awful that I did not want to be. I was being told how I was and was not allowed to birth MY child and what I could or could not do with MY body. All of the stories I had read and all of the birth videos that I had watched, my experience was absolutely opposite of it all. About the time that I started to lose it with all of the staff and violations, I ended up giving birth vaginally to a 9lb 10.9oz baby boy, lying flat on my back in the exact positioning that I did not want to be in! To make matters worse, the doctor decided my placenta was not coming out fast enough, so she decided to stick her entire hand inside of my uterus and extract the placenta. I later learned that it often takes time for the placenta to be delivered and it is completely normal. My son should have been put to breast to initiate contractions for placenta expulsion, but instead he was taken away to become a science experiment himself. During birth, I had torn inside and felt the suturing because my local had wore off, not to mention it did not feel pleasant with her hand rubbing against my tears as she inserted her hand. My son was taken away from me to get weighed and have other things done of which I could care less about instead of being put to breast and receiving skin to skin. I literally felt like I had grown this beautiful life inside of me for 9 plus months and I did not even get a chance to bond with him following birth. I so badly craved skin to skin and breastfeeding while I got to really KNOW my little guy. He was handed to me at one point wrapped in a hospital blanket and I could not even see his face. His face was finally turned where I could see him after I said something to them, but he was given to his father shortly after since I could not handle the pain of her hand and all of the pushing on my uterus. I could not enjoy my son. Then to make matters even worse, I had lost a lot of blood and was not completely "with it". I was drifting off while they were explaining all of this nonsense that I discovered next. During Kody's examination they found that he was missing an exit to his urethra, as there was a dimple in the usual area at the tip, but no exit. It turned out that he has a simple case of hypospadias, which the incomplete foreskin would have been a huge give away of for diagnosis. She missed the fact that his foreskin was incomplete and the fact that he indeed did have an exit, but it was slightly lower and to the side. They informed me that he likely did not have a patent opening and that he would need an operation, where we then were talked into giving the Vitamin K injection that we had not originally opted for. He did not need an operation nor did he need that injection. Kody was sent downstairs away from me, while I involuntarily passed out from absolute exhaustion for a couple of hours, waiting for the urologist specialist to see him. He received an ultrasound of his kidneys and urinary organs, which came out normal. Hours later I finally was permitted to be wheeled down and see my son, for what felt like the first time. It was all wrong. It just all felt wrong. He had an intravenous catheter and all these contraptions hooked up to him in that stupid heater compartment. My poor little angel put through so much pain right after entering the world. He was not permitted to breastfeed, something I wanted so badly and instead was on fluids. I held him and there was no connection. I did not "know" my son. I did not feel immediate love. He was taken from me after birth as I said and with the entire process, things were totally off for me. We had discovered before heading down there that there was no specialist working with Providence and that he would need to be transferred via ambulance to another hopsital that was capable of diagnosing our son, of which we chose University of Michigan. We spent only a brief time holding him before the ambulance staff arrived to take our son away. He had his first bowel movement, the meconium and they changed my son's first diaper instead of I. My baby was going to another hospital without his parents and they put him in this odd device to transport. I selfishly asked Clinton to stay with me as I was afraid to be alone. I did not feel right at all and I wanted him, my comfort person by my side. Looking back I wish he went with our baby and made sure he knew we loved him and was safe, preventing anyone from mistreating him or doing anthing "off" with him. The doctor called us from U of M, I want to say early the next morning and informed us that it was a simple case of hypospadias and that I could alter him sometime after 6 months if I chose correction. I was extremely relieved, but now my baby was still miles and miles away without us. I had sent over pumped colostrum, that I had been expressing shortly after I woke and before meeting with Kody. I received a call the next morning from them asking permission to feed formula. I consented because I had not wanted to "starve" my baby, but now looking back I would have opted out of the formula and got over to my baby asap to feed colostrum, whi
ch is all the poor little boy needed. I was discharged Wednesday evening and finally got to pick up my little boy who had been born Tuesday at 8:13 am. The entire process I had an abundance of people concerned about Kody and trying to contact us and see what the news was, which honestly did NOTHING but add to my stress. I did not have time to be visiting with people and letting them know what was going on with MY son. We were already going through so much stress and trying to situate everything ourselves as a family. Anyways, I got to feed Kody inside the hospital and the nurse brushed off asistance and said that everything seemed to look right. I brought my son home that night and our breastfeeding began. It was a horrendous experience initially. He was so traumatized and out of it the first night with us that he near slept through the entire night. I had to wake him repetitively and in fear of milk supply issues I coerced him to eat. The latch was not right as his lips were not far enough apart, since he had no interest in anything other than his comatose like state. He caused damage to my right nipple, where there was cracking and bleeding. With each latch, I would want to SCREAM. I was in tears non stop. I would NOT give up on my little boy as I KNEW that formula was NOT adequate for MY little angel. I stuck it out but it was hell for at least a week. Looking back now, I know that I got lucky actually because some women have a much longer duration of lack of comfort than that of which I experienced. There was a time where i just snapped and had to give the crying and hungry baby to Clinton, walk out the door and have a breakdown in my car. I still feel bad that my little baby needed his mommy and I was incapable at that moment. I was having a REALLY rough time with the transition into motherhood and breastfeeding after the insanely traumatic experience that my family was forced to endure. I suffered incredibly horrendous post partum depression and my traumatic birth experience was largely to blame, actually mostly to blame. I ended up making it through breastfeeding and I exclusively fed my little boy until 7.5 months when he showed that he indeed was ready for solids. I am still feeding my 14 month old son and a very large portion of his diet is still breastmilk. I made it through work, an internship and a veterinary technician program while suffering pumping struggles and people giving me a hard time about adequate pumping sessions. I had to be separate from my son far too soon, but I made it and have NEVER been more proud of something. I seriously feel that with everything out of my control with the birth experience, breastfeeding is the other passionate area that I CAN control and that is going as planned. I am extremely passionate about our feeding relationship and have never been more proud of myself. I cherish every session and am incredibly happy that I have gotten the opportunity to experience such a beautiful and intimate experience with my son. I genuinely owe breastfeeding, bed sharing and baby wearing to the close and intimate relationship that I now have with Kody and I can honestly say that our relationship was largely healed and brought together through these areas. I willl be forever grateful that I gainedk knowledge in these areas and brought them into our relationship. My PPD was so severe and my lack of feelings for my son given the separation and trauma of the experience were a reality that could have easily hindered our entire relationship throughout both of our lives. Yes I would have loved him and things would have worked out, but adequate is not good enough for me. I want the best and most intimate relationship that I physically can have with the lives that I create. The relationship and closeness we share throughout our infants lives carries on into the lives of our adult children. I strongly believe that and I have never felt so intimate or close with another human being through my entire life as Kody. I genuinely believe that birth is where the intimacy and bonding begins and it is CRUCIAL to a families relationship. Unfortunately my family was robbed of that experience due to hospital birth's protocols, staff's inadequacy and incompetence and just the overall outlook of birth in our society. It is possible to make up for the lack of birth bonding, but it is indeed challenging as I have learned the hard way. I honestly cannot say whether or not I will ever be healed of the traumatic birth experience of Kody. I have received counseling for my mental struggles surrounding this area and I have tried my hardest to be positive and think of the good in the experience. I have a beautiful and healthy baby boy that adores his momma and I too adore him. I managed a Pitocin induced birth analgesic free of a near 10 pound baby and I came out as a stronger woman. I managed to push through all breastfeeding struggles and do best by my son and I. I am an amazing mommy that always tries to put her son's best interest first and thoroughly research anything that will affect Kody. I have changed myself, becoming a more mature and strong woman. I am a mother and a damn good one. I don't go off of what is the "easiest" parenting technique, instead I go off what is the ABSOLUTE BEST parenting technique for my little muffin and I. I have to constantly remind myself that my body and I did not fail my son, but in fact the medical model surrounding American birth indeed failed us. They are failing birthing women, their babies and entire families each and every day. All that I know is that BIRTH DOES MATTER. I strongly believe that we need to FIGHT for women and their birthing rights and that we need to make a conscious effort to stand up against the flaws of this country's medical model surrounding birth and help to make a positive change in the BEST interest of birthing mothers, their babies and their entire families. Make INFORMED DECISIONS and do not let yourself fall victim to being "just another patient" as a birthing woman in the hospital setting. BIRTH MATTERS.

Anita

Aviva,
Thank you for such a great article. 27 years ago I argued with my obstetrician about having an episiotomy and receiving no medicine with my second child. He actually was a great OB and allowed choices but said "If your bladder falls out when you are forty, don't come crying to me." (Jovially) I delivers a 10lb 2 oz daughter and subsequently 2 more 9+ lb babies with no episiotomy's and my recovery was much, much faster and my experience much more enjoyable. I'm happy to say, I'm 50 and my bladder still remains in place and I'm so glad I argued. Having been the birth experience with 3 of my 5 grandchildren I can tell you I feel so sorry for these young women. They are so stressed out during their pregnancy with the stringent diets, and fear mongering and basically the minute they step into the hospital they are bullied told what is going to happen next. All three of my daughters were terribly disappointed with their birth experiences. All I can say is thank you again for making birth what it is... natural.

Nichole

Thank you for such a clear article on what women face while giving birth.
I have six children, all c-sections. I was 22yrs and seeing a mid-wife when pregnant with my first, and was planning to give birth at the Midwives birthing center. I was seeing the same mid-wife who I had witnessed deliver two of my younger siblings in my parents home. But due to a complete placenta previa, I had to change my plans to a c-section so my daughter would be born before I would go into labor. I was lucky that I was able to see a doctor who had delivered one of my younger siblings, so I was already familiar with him, and his wife would be doing the amniocentesis to check my daughters lungs for maturity. She was born just after 37 weeks- 6lbs 5oz of attitude with thick, dark hair. The surgery went without complications but the recovery was hell. I was given morphine, to which I reacted horribly, and that was after I already had a reaction to whatever they had put in my IV during the surgery. By the time I was aware enough to nurse my baby, she had been given bottles by the nurses. I tried to get her to nurse for six months, talked to lactation consultants, tried a nipple shield, tried only water in the bottle. Nothing could get her to nurse. She was jaundiced for 4-5 months, colicky for nearly 7 months. We went thru every baby formula on the market, even using goats milk, but eventually she would be projectile vomiting as soon as the milk hit her stomach with every formula. It wasn't until she was eating baby food that she was feeling better. I had a breast infection and an infection in my incision before I left the hospital. I dealt with abdominal pain for at least three weeks, despite my pain meds.
My second child came 13 months later. We had moved to another state 3 months before her due date. I was able to find a doctor who was willing to let me try a v-bac, but only after having an ultra-sound done to prove my incision had healed properly since my first child. My water broke on her due date. After several hours of labor I felt like I had the flu. Turned out I had an infection. The doctor gave me pitocin to speed up my labor. All it did was put my baby in distress. I had been using Hypno-birthing techniques, something I had wanted to do with my first. I felt awful due to the infection but my labor wasn't anything more then discomfort. The moment my doctor said we had to have a c-section, I was in pain. The surgery had some difficulty- my daughter was already in the birth canal. They had to pull her out of the canal, then push her (literally push- I had 3 people crushing down on my abdomen) out of the incision. My torso was bruised for weeks. My daughter was in NICU for several days; my nearly 10lb baby next to these tiny 2 or 3 lb babies. My recovery was only a little better then before. I did not have feeling return to my right leg for more then two days.
We had moved again when I was pregnant with our third. After many phone calls, I was able to find a doctor willing to take a chance on a 7month pregnant women wanting to try a second v-bac. My water broke a week after her due date. I labored for 36 hours then my doctor came in and gave me the news that because of "failure to progress", I needed to have a c-section. This time I had mentally prepared myself for it so the words didn't cause me to feel pain. I was able to keep with my hypno-birthing techniques while they put the needle in my back, and thru the dry heaves and chills during surgery. My daughter was healthy. I had an infected incision for the third time.
Of course when I became pregnant with my fourth, my doctor told me at the first visit " Now you know this will have to be a c-section?". #4 & #5 were both boys, the surgeries were okay, I had low blood pressure with #5 that made me keep passing out, my incision got infected. By the time #6 was coming I had been seeing the same doctor for 6 years, and not only had he already delivered 3 of my children, but he had performed an ectopic surgery on me in which I was bleeding internally. He has my complete trust. But he also trusts me to know my own body, to know what I am feeling and to know when I need him. After my last delivery I was released from the hospital before my daughter due to breathing problems she had along with something else having to do with her having a different blood type then me (I can't remember exactly what it was). I refused to leave her there without me. My doctor ordered me moved to another room so I would be out of L&D but still near my daughter. That night I could feel an infection starting in my body. The nurse checked my temp and I was within normal (I run at a low temp naturally). I insisted she call my doc- he sent in a Rx for antibiotics.
My recovery after my sixth child was very good. After kicking that initial infection as it began, I had no other infections. I was able to spend more time with her relaxed and bonding then I had with any of my other children. I'm not sure if my body is getting better at handling the surgeries, or if my doctor is getting better at treating me. Either way, c-sections are a life saver for me and my children. But every time I got pregnant I couldn't ignore that I was in for major surgery. I would have far preferred to have a natural birth. And if I could, it would be a home or birthing center birth.

aviva

aviva stavsky

when I was pregnant, I thought home birth was a nice idea, but I wanted at least my first birth done the "standard" way, in a hospital. I'm glad I did. I and my daughter both would have not come out of that hospital alive if not for immediate medical intervention.the monitor was able to tell that her heartrate went way down from the pushing and had to be vacuumed right away. after birth I was hemorrhaging and had to go in for stat surgery. what if we'd have been at home?

aviva stavsky

B

Aviva, I'm sorry for what happened but hopefully your baby is healthy today. Birth is *usually* a complication-free process in the right environment which can be a hospital, home, pool, lake, etc. If you would have chosen a homebirth, you would have hopefully had someone competent there to monitor the baby and watch out for these situations. As much as you think your situation is unique, there are a lot of other rare situations that midwives are TRAINED to handle. Most certified nurse midwives have attended enough births to see complications before they arise and they know when to transfer to the hospital. Think of it this way...instead of taking you and your baby to the hospital, you bring the hospital (the midwife and all her associated tools and medicines) to you and your baby. If you need anything more advanced than what the midwife brings with her, you can transfer to the hospital and get what you need there. A study came out of Canada a couple years ago saying the transfer time into a surgery room was the same for women giving birth in a hospital as for women who were transferred to a hospital. Maybe Dr. Romm has more insight on this? Here's a link I could find quick - http://www.cbc.ca/news/technology/home-birth-with-midwife-safe-as-hospital-1.862485
Note that this study says that women who planned a homebirth are 0.62 times less likely to have postpartum hemorrhage. Anyways, it's all about choice and freedom and mothers always want to do what is best for their babies.

Abigail Julier

I read your intro to the end, and tears swelled up more than once. I look forward to the day where we don't have to explain nor fight for how a birth-day should be. All women and children deserve the opportunity to experience this moment.
Thank you for offering such a beautiful view through the eyes of someone so diversely experienced in birthing and women's health. I appreciate your steady and passionate stance on a subject that could never have too many supporters or leaders.
Thank you,
Abigail Julier

Ang

Thank you, Aviva. If only the medical profession would fill up with more like-minded doctors. I walked away from my own OB practice at Yale after it became abundantly clear to me that my "choices" were a joke and the "care" I was receiving was not in the best interest of myself and my baby. Two midwife assisted (glorious, safe and triumphant) home-births later, I am now pursuing my midwifery education.
One aspect that I think is missing in your (awesome!) article, and one that I find women are missing across the board is the level of personal responsibility one must be willing to accept to make these informed choices in the first place. Whether under the care of a doctor or midwife, women need to own their health. I find that "typical" care under OBs directly or indirectly informs women that this responsibility lies with the care provider and that contributes to many women being swept on the whim of any medical practice, scientific or not ("Well, my doctor said..."). I wish there more discussions about this, that truly challenged us all to be responsible for our health, or births, our babies ... instead of shoulder off all of the responsibility to our doctors or midwives!!!!
Thank you so much for what you do. Love, Angie

aviva

Thank you, Angie, and fantastic that you are now becoming a midwife! YAY!
I agree with you. I believe this is a result of decades of a "leave it to us little woman" attitude combined with women truly not knowing what questions to ask, how to sort out the data and take that responsibility -- especially in what can feel -- or even be-- vulnerable circumstances. For example, how is a woman, unless herself a health professional -- and a birth professional at that, -- to know whether she really needs that c-section when she is told her baby is in distress -- that's a tough call to make in the middle of a 2 minute reprieve between contractions. It's soooo complicated! And I agree with you. Thanks back! Aviva

Marguerite

Dear Aviva,
Thank you for your story. I am a Dutch woman, mother of 3. The 2 oldest were born at home, in my livingroom. The youngest was born in hospital, because she was breech. In The Netherlands that means it will be a medical birth due to a higher risk. All 3 were born vaginally.
In The Netherlands we have a good birthing system, with a lot of home births, though there are gyns that state first babies should always be born in hospital.
I was really scared of going to hospital for giving birth, and both my home births were wonderfull. When I needed to go to the hospital, I refused to be hooked up to a machine when that meant I wouldn't be able to walk around. Fortunatly I still could walk around a little. There was never anything hooked up to the bottom of my baby after my water broke.
In our country, the training to become a midwife is a 4 year training in college, not university. And when needed, the transfer to hospital and to medical care is smooth. In most regions, we don't live more than 20 minutes from a hospital.
Also, it is very common (and unique in the world) that a specialy trained nurs (kraamverzorgende) will come at home about 4 to 8 hours a day every day until the 8th day after birth. She (most of them are female) do the daiyle checks of the mother and the baby, she will tend the other children, help with the breastfeeding if mother wants to, does the cooking, claening of the toilet and bathroom and the rest of the house. The midwife comes in to check a few rimes, even when one gave birth in hospital.
I love our dutch system, and hope it will remain to exist for my daughters (born in 2000 and in 2007) and their daughters and granddaughters. Giving birth at home is the best (if medically possible of course!)

Gauri

Thank you Aviva. As a medical doctor - with one homebirth during my studies and another home waterbirth a year ago - I resonate with what you say. I have worked in obs wards and seen many sick pregnant ladies, unnecessary interventions, and necessary interventions, sickness, HIE, death....disempowered....abused.....and also wonderful connected, happy and lovely births at home and in hospital. But there is nothing like a homebirth.
I would do it again too! And again!!
Hospitals have a place but the medical paradigm does often not fit birth nor pregnancy! You have said it all....wonderful wonderful!!
Birth is such a powerful catalyst opportunity for women to gain their power and self...I hate to see women robbed of it by a medical world that doesn't understand it.

Jen

Not sure what the big deal is? Isn't the only real goal is for there to be a healthy mom and a healthy baby at the end? Why does it matter how it happene? I had zero risk factors going into pregnancy and ended up having a c/s with a GA. Guess what, I didn't breast feed so at least a day and 11 years later we are super close. It is a myth that you need to start breast feeding while the baby is still attached to the placenta or you won't bond.
I'm not sure why we want to go back in time and deliver at home. 1 in 4 women used to die during child birth, why do people want to bring those statistics back?

aviva

hi jen
for some women the psychological experience of birth is very important --- perhaps for others not so much. but if a woman FEELS it is then that is important. and of course, breastfeeding is not necessary for bonding -- many women don't and are great moms and love their babies just as much as any other. birth at home is not going backwards and is the norm in much of the world -- safely -- and with better outcomes than we have in the US and much less cost to the federal deficit. What's right for others might not be right for you -- and that's ok -- and in fact, one of the most important pieces of this issue -- along with making it possible for mothers to have access to reliable care in all settings. best, aviva

Mariella

I think part of the problem is attitude. I have a friend who does home birth and she (but mostly her home-birth friends) are SO militant, it's very off-putting. Your article is well-balanced. The ladies I know are 100% against hospital births and act like a woman is terribly harmed and disadvantaged if she gives birth in a hospital. One lady would say, "Oh, honey, I'm SO sorry," in this pitying, horror-filled voice, if anyone mentioned giving birth in a hospital, even before she heard whether it was a bad experience or not! I had two babies in hospitals, 21 years apart. The first baby likely would not have lived, and I was in danger, without intervention. He was too big, totally stuck and stressing beyond belief, they ended up using a vacuum extractor and we both ended up fine. My second I could have had at home just fine, but with only the one to go by, I didn't want to chance it (plus being over 40 worried me, although I know more women are giving birth later nowadays). However, in both cases, I stayed in a nice homey labor room for all the labor (for the whole birth the 2nd time around), with my family there and it was not "hospitally" at all (in fact, my first son was in the room for the birth of his little brother! But he stayed in the corner til it was finished. :) ). At our hospitals here in Alaska, they try to make it very home-like, with decor and low lights, no hubbub, etc. Anyway, the home birth women I know are just awful and I think they make women who can't or don't want to give birth at home feel less-than. That is just not okay. I don't feel less-than, because I know they are just ignorant. I feel blessed that I had the help I needed when I needed it and that I have two healthy babies! Thanks for the insightful AND kind article; it helps facilitate the conversation instead of shutting it down like the militant women do.

Cheryl

I had 2 cesareans. Completely unnecessarily. My ob wanted his schedule, his timing, all about him. Nothing about my health. I was loaded with anecdotal stories that were irrelevant to facts. I was told my baby would die, that I had to listen to him. The second cesarean nearly took my life. As I lay on the table dying I remember praying to God to save my baby. Never again would I do that. I had my son at home. It was the best decision I ever made. I will forever home birth now.

Sima p

Dear Dr. Aviva, thank you for this informative article. I am currently expecting baby boy #2 in may 2014 and have few questions since my first born son in august 2012. I had my baby at white plains hospital at 39+4 days. I delivered vaginally and was preparing for this birth throughout the whole pregnancy. While i was not comfortable about home birth due to lack of info and expertise around me, i was going for a natural birth and hired a midwife who is part of my obgyn practice i belong to. I explained to her my wants and needs and she assured me that she also thrives for her moms to have natural births. At 39 weeks (tuesday) she said she was going to "strip the membranes" which i did not question out of my trust, the next day (wed. late afternoon) after spotting i felt as if i was peeing myself very lightly and during the night felt menstrual cramping. The next morning ( thursday) out of a slight concern i called my ob office to speak to my midwife who was out that day and i asked to come in to see ob in the office just to make sure all was ok. I got to the office at 10am and attending ob in shock announced that my water broke and i have no water showing on the US. Questioning me when did it happen and why didn't i come in sooner. I explained what happened with my midwife earlier in the week and that my anticipation for a gush of fluid to come out of me never happened. So here i was 30 min away from home with nothing on me being sent to the hospital immediately. You can only imagine my shock and scare at that moment all on my own. I called my husband in tears and explained that he needed to get to the house get my bag and come to the hospital as i needed to have this baby now. Arriving to the hospital i was placed on a fetal monitor and course of antibiotics for being septic due to the lack of water and possible infection....there goes my plan for walking around... I thought... An hour later i was told that my contractions were very light and induction had to happen... There goes my plan of natural unstimulated birth...i thought. This is all while i am alone in triage waiting for my husband and no midwife in site. Lets just say not a good feeling. At about 2pm i was induced and my contractions skyrocketed and at 4cm the pain was unbearable....there goes my breathing and hypnobirthing practice...i though...actually at that moment i could not think any more consumed by burning antibiotic iv in my hand and uncontrollable contractions. I demanded ipidural and got it 10 min later ...there goes my no drug plan... I thought and tried to sleep and relax. At midnight my midwife showed up and said that soon will be time to push. To make story short...i pushed for 3 long long hours nonstop and my son was born at 3:36am on friday. Baby was still high and his head was tilted back which made it hard to push. At some point my midwife said that if this baby is not coming out in the next 20min, ob will take me for CC. Scared out of my mind and trying to get some air out of oxygen mask i pushed with anything i had left in me and The attending ob and my midwife performed episiotomy (another thing not on my list) and with help of suction got 8.2 lbs baby out. He was just perfect and while i got stitched up my baby was trying to nurse. He was taken away an hour later for routine checkups and i was transferred to my room. My husband went home to get some rest and at about 6 am i was told that baby was taken to nicu due to lower white blood count and possible infection so routinely antibiotics had to be administered while our stay...there goes my plan to keep baby in the room ..i thought. I said i would come and feed the baby every 2 hours and just few hours after painful birth and feeling torn up due to episiotomy i was going back and forth to the nicu unit. No family was allowed to come to nicu but my husband and grandparents, which was pretty sad considering how many people waited for this baby with me. We were discharged on time in good health and went home. My son is 17 months now and is truly best thing in my life. To get to the point.... I am having reservations about next birth in may and would love your input. I plan to tell my midwife that no stripping of any kind will be done as i feel my first son was not ready to be born, had she not touched me he might have come a week or more later on his own. Is that a fair thing to ask for? Also she told me that i will be put on iv no matter what as i am bstrap positive. Is that absolutely necessary? One of my friends told me that my midwife is" fried" at this point in her life and career and was supposed to retire last year but now waiting for end of this year. Should i be concerned and maybe look for a new practice and new midwife and what am i allowed to refuse in the hospital, i feel as if they pressure you and don't give much choice in any matter. I am scared to look for new hospital and new midwife due to unknown, and overall nurses where very nice and supportive to me. Any advice you can give would be greatly appreciated. Thank you!!!

aviva

Hi Sima,
Sounds like a very stressful experience and I can see how you'd feel anxious about your next birth. I'm glad ultimately everything was ok was your little boy. There's no excuse for a midwife stripping your membranes at 39 weeks, nor without informing you. The data shows that it is very effective for starting labor -- so it is like being induced. I would definitely talk with your midwife about your expectations -- or better yet -- find another. As for the GBS, you may be able to forego it if you have a quick labor -- you can check with you midwife or OB. But if you plan to birth in the hospital then yes, if you've had GBS in the past, you will likely be treated for it again -- if you don't get treated and your baby ends up with any fever then your baby will get the antibiotics anyway -- so in that setting ,better for you to get them. As for the pitocin, epidural, etc -- this is your choice so now that you know you don't want these, work with a doula who can support you and also make your wishes known ahead of time that you really don't want these interventions unless absolutely necessary -- and then you have to be informed and so does your husband as to what constitutes truly necessary -- which can be hard because you naturally want to do everything for your baby and those are tough decisions to make in labor. Also, you can talk with your nurses when you do arrive at the hospital and ask them to help support you and to help you understand what truly is and isn't necessary. L&D nurses often have a good pulse on this, a lot of experience, and don't actually always agree with the OBs and midwives so may have some good insights for you. Best wishes!!! Aviva

Megan

Hi Aviva!
After my sister-in-law became pregnant and chose to have her baby in a birthing center rather than a hospital, I was inspired to research the pros and cons of each experience. After doing so I feel that I would like to go through a birthing center for my future pregnancies. My first pregnancy was done in a hospital and I feel that it was the best choice at the time for me because I had developed HELLP syndrome. I was wondering if you thought that I would be able to use a birthing center for future pregnancies or if the hospital would be best for me because of the risk of developing HELLP syndrome again? Thanks so much!

aviva

Beatrice

This is a very interesting article, Aviva. Honestly, when reading it and many of the comments that are left below, I find I'm feeling like I failed in caring for my own two babies, even though with my nursing background and limited options in my rural area, I don't know that I had much choice given the circumstances, so I thought I would see what your experience was with this issue. My first baby was induced due to a PUPP rash at 40 weeks +3 days with 2 cm dilation x 1 month, however the Pitocin was never increased much as it was causing decels for the baby. I did not have an epidural until I was already pushing and I suspect that was strongly encouraged as they knew it might be a challenging birth. Long story short, we ended up with a c-section, healthy baby and a tough recovery on my end for a lot of reasons, but the main issue was cephalopelvic disproportion - failure to descend. My question for you is, in your experience are VBACs ever a safe option when that is the history? I had 2nd baby with a planned c-section and it was much smoother but my OB told me that the chance of being able to deliver vaginally was very low since the first baby (just 6-1/2#) was so jammed in there (her head was really stuck). Looking back, noting that all my pain in the last trimester and throughout my labor was really in my lower back/sacrum, it makes sense that maybe my pelvis was not loosening up the way it maybe needed to? Thus, I'm grateful for the fact that I had the c-section option and while the deliveries went the way they needed to at the time, I am sometimes left wondering if there were other options? I was able to move around a bit, I was changing positions while pushing. Just thought I would see what your experiences with this issue was.

Beck

Awesome article as usual Aviva! I had a home birth almost 11 months ago and I would do it again. However I would say I was a victim of the midwife "Wild West" as you say and I would redo choosing a midwife if I could. Hindsight is so dang perfect. I really appreciate your balanced views on issues like this. It is very rare!

Lindsey

Thank you for this wonderful article. I've had my first two children in a hospital & while the first went well I was induced with my second (not knowing the risk & not educated at the time) and had serious complications. I knew after that, that this was not natural & I shouldn't have went through with it. As we are planning for our third baby I have been looking into having a mid-wife & possibly a home delivery after reading your site, articles & starting research on my own. This article has really helped me understand some of the issues that I didn't see before & every woman should know these things!!! Thank you again!

Nancy

Thank you Aviva,
My son and his wife have chosen to have a midwife and deliver at home. I was very concerned, but after reading a few articles including this one and watching "The business of being born" that my daughter in law had suggested, I feel much better and more informed. I had no idea how the rate of c-sections had increased, and the downside of them. Also the adverse effects of having pitocin and other drugs during childbirth, and how frequently they are used.
I had my children in the 80"s and they were all born "naturally" in the hospital, the only drug I had was Novocaine before the episiotomies, which I had with each birth. But I did tear with the last one, the Dr. was too slow, I think I was one of his first births, he even had trouble getting his gloves on, my husband was about ready to step in and take over.
Thank you for educating, and sharing home birthing from your vantage point, now I have much more unbiased perspective.
Thank you from an excited, and nervous, first time grandma,
Nancy

Pamela

aviva

Hi Pamela,
Finding a midwife can be a challenge in various communities. Here are some suggestions:
1. Go thru the ACNM -- see if there is a CNM in your community
2. Go thru MANA or NARM to see if there is a CPM in your community
3. Know what you want, including safety aspects and transport issues.
4. Interview carefully and get letters of recommendation
5. Trust your instincts!
I'll be writing more on selecting a midwife.
Best wishes! Aviva

Gordon Gibson, MD,MPH

Graduated from Emory Medical School in 1965. While in training @ Grady delivered over 200 babies and after that only a few, mostly because I worked a lot of hrs as an ER physician and the OB folks were too slow, No tears, bloody complications, or Apgars of less than 9. I always felt that there should be more positive input by the mother than seemed to be the case but knew nothing of the whole field of midwifery. I've been retired since 1998 (old ski-neck injury) but have enormous respect for your story and those of the mothers who have been brave enough to have their babies outside of hospitals. Insurance companies do great harm in pursuit of profit.

aviva

Melissa burgess

That's wonderful that you were able to birth all your bubs at home :) I feel robbed after having my first c section, it didn't really bother me at first because I knew they had to get him out but after falling pregnant quickly after and my net was due only 15 months after, they didn't want me to try naturally :(
I had dilated to a full 10 cm with my first with barely any pain but baby could not be seen down there, having had my c section after fully dilating I bled a lot and needed transfusions.
So as for 3, 4 and 5 they all had to be c section even though they would always ask me how I wanted to do this and I would reply with " I would love to push them out" they just laugh and say another c section.
I am now so upset as I have been told not to have number 6 as my uterus may break, is this true ? I am devastated and so is hubby as we can't adopt now either as we have 4 biological children :( we love having our big family and would have loved more.

Juliet

Thank you for your honest look at different birth options. I am 37 weeks pregnant with my 7th child and am giving birth at a birthing center with midwives for the first time. I am very excited about it!! All of my other births were in the hospital. My first was amazing.... it was a completely natural birth in the hospital - no IV, no interventions - just a perfect birth. That doctor moved out of state and I suspect it was because the hospital policies were trying to tie his hands of allowing women to birth in the way I did. After that I realized how rare that experience was. The next birth the doctor scared me into scheduling an induction at 38 weeks because I had a long drive to the hospital. I still refused the epidural, though, but I was tied to the bed and the pitocin made the labor SO much more difficult to endure than it was my first time. After that each of my births involved OB's telling me they were okay with me waiting and even going over my due date only to have them try to talk me into inducing. The end of my pregnancies became several weeks of me having "discussions" with my doctor. Having to argue over something I thought was already resolved was just exhausting and honestly made me want to skip my prenatal visits at the end of my pregnancies. Not to mention, laboring without an epidural is much more difficult when I'm given pitocin (still have never had an epidural, though). I do wish the OB's had just been honest with me from the beginning that they were going to push for induction. Anyway, I am thankful for my midwives and the birthing center I found! There will be no arguing this time! I do get the sense from some doctors and even nurses who work in the hospital that a lot of times the hospital policies are tying the hands of physicians. I do wish that would change and hope and pray the birth climate in the U. S. will improve quickly.

D Willis

Amy Berg Pickett

I am so grateful for the article! I love when women empower other women to engage with birth from a place of power and love. I am going to share my story for inspiration purposes. I have five children and I have had five home births. Four with midwives that I trust 100%, all the births were different, safe, and satisfiying. I feel very grateful and blessed to have realized at 22 that I wanted a home birth. I am now 45 and just birthed a baby one month ago. Home birth for me has been an excellent choice. I feel safest at home without unnecessary practices or interventions. One of my biggest hopes is that birth gains the respect that it deserves as a natural process. Thank You for your time,

Jodi

I am not alone!!! Hallelujah!
Thank you so much for your article. I am currently undergoing my residency in Ob/Gyn although I was a doula and natural childbirth educator before going back to medical school. Although I am not currently pregnant and have never before given birth, I can most definately say my last 3 years of training have verified my desire to have a home birth when the time comes. I freely discuss this much to the dismay of some of my collegues.
I was so tickled to see that another physician in the field has made a similar choice in her own birth experience and am so glad you have the fortitude to speak out about it.
Thank you, thank you, thank you. If you ever take rotating residents, please let me know.

Stephanie

I've had eight babies - the first four in a hospital "their way, the fifth a precipitous birth waterbirth with midwife at a pilot "shared care midwifery program at a hospital (which was quickly dismantled, and the midwives medicalized), and the last three unassisted home waterbirths. Thing is, i have quick, uncomplicated births. So why do i have to bear all the yuck of hospital births (the external monitor, the "just in case" IV lock, the pressure regarding vaccinations and eye ointment, even just the unrelenting smell of the place, and all doorways jammed with mentally ill chain smokers? I also tend to dribble amniotic fluid midway through my pregnancies, and last pregnancy my pelvis was very much destroyed (tons of relaxin plus an awkward fall at the pool). But there was no doctor who could give me any kind of advice or help unless i signed a paper promising to deliver at the hospital. It just seems so money grubbing, so unthinking and unreasoning and heartless. I am glad my husband is willing to support our homebirths, but i also realize i am really blessed, and i feel for women who have no choice. Because i honestly believe that women have fewer children rather than submit to the bullying and degradation and condescension of a hospital birth. In my province, i think less than a dozen midwives are registered, and our provincial medical plan does not cover their services. So, hospital birth is free, but a midwife attended birth is 5000$ and likely with an unregistered midwife, if you can find one (the closest one i could find was 4 hrs away - my fastest labour was one hour from the first contraction.)

Kat A

Thank you so much for this post, it's one of the most balanced posts on the topic of birth location I have ever seen. I've had seven births, everything from medically unnecessary induction nightmare, to blissful home waterbirth and peaceful recovery in my own home.
I'm also a mom who experienced a tragic neonatal loss due to a homebirth midwife who exaggerated her qualifications and experience. She came with glowing recommendations from moms and from the midwife she "trained" with so... Not sure how much else I could have done in the way of due diligence, she was even "certified" with a DEM organization. In hindsight the fact that she had no backup midwife or assistants was a slight red flag, but everything else seemed rosy.
The local home birth posse circled the wagons after, no one reached out to me, and I mean No. One. I found out later, secondhand, that some of the more prominent midwives were spinning my situation as "just one of those things" and any dissatisfaction I might have with the complete and utter incompetence displayed as the hysteria of a grieving mother. For the record, I never once spoke out against the irresponsible party. I didn't start a social media character assassination. I was too busy just trying to survive waking up every day to the realization that my child was dead. Remembering to breathe was quite enough to keep me occupied, thanks.
They never once contacted me to find out anything that happened that night. They didn't see the panic on the face of the "midwife" I trusted, they didn't watch my baby's legs turn blue as he came footling breech and got stuck.They didn't help my husband as he finally realized nothing was going to be done to help me, and called 911.
After my tragic loss, I had a hospital birth with an *actually* experienced midwife. It was excellent, and everything went so well we were home that same day. Baby born at 9:15 am, I was resting comfy at home by 4pm.
And then six years later I had a medically necessary surgical birth after seeing the same excellent midwife for pregnancy care. Because I knew she knows her stuff, and because I had met the physician who worked with her, I had utmost confidence that when they said "This needs to happen NOW" it was for my safety and my baby's health. The trivial detail that it was midnight on a Saturday night had nothing to do with the situation (and yes, there ARE doctors out there who perform surgeries on anyone who has the bad luck to be in labor after 5pm on a Friday night, just because they can).
My baby spent 3 days in the NICU due to the distress he was in, but next month he will celebrate his 3rd birthday, thanks to life saving medical assistance.
There are so many voices shouting out there about this subject. Some are saying hospitals are EEEEVIL. Some are saying homebirth is always irresponsible and ignorant. We need more voices willing to talk about the issue with the kind of balance presented by this article. Thank you!

aviva

Ruth

I am proud to say that I work for the #1 pediatric research facility in the world. My daughter is a very astute and well researched supporter of home births. You can imagine the conversations and tug-of-war discussions we have :-)
I thought Avvia's article was excellent. Many salient points from both sides of the fence. Well written articles such as this have a tendency to sway old folks like me, stuck in the old way of doing things, to consider the alternatives as plausible. Teaching old dogs new tricks is hard - but Aviva has written a convincing and obviously highly knowledgeable article. Many thanks!

Melanie

Hello! I know this article is a few months old but I hope you can reply. I had a vaginal birth at a hospital with my first daughter who was born with a heart defect. We knew that we were going to need medical intervention to keep her alive before she was born so we didn't have a choice. I'm now 17 weeks pregnant with my second and so far he is looking healthy. If his heart echo comes back normal and healthy, what are your thoughts of a home birth for this one? I've just dealt with so many hospital visits and doctors with my daughter that I don't want to miss out on the important things right when he is born because I know how they can be. I don't want to have to fight to get what I want and know is healthy for my baby.

Janel

I have a five month old, breastfed boy who was induced at forty weeks due to my having antibodies for both Hashimoto's and Grave's disease. The induction sadly ended in a c-section when his heart rate continued to drop into the 50's with each contraction. My question is in regards to preventing my son from developing his own autoimmune disorders. I realize that the c-section caused him to miss out on early exposer to vaginal bacteria, which can help prevent autoimmune disorders. What can I do to help remedy that situation? Thank you for your time and consideration.
Sincerely,
Janel

aviva

Hi Janel, So sorry for the long delay. I answer my own comments and got quite behind with a move and the birth of my grandson this summer! Sorry you had a tough birth experience -- but sounds like you did exactly what was needed for your son! Breastfeeding if you are able, and a healthy, organically based whole foods diet can do wonders once your son starts solids. Pay attention for issues like colic (though even if he had that he's probably outgrown it by now!), allergies, and eczema. These are early signs of the "atopic march" -- or the possible impact of gut flora issues on systemic health. IF you see any of those, or even if you just want to be cautious, you can use a probiotic. I use Klaire Therbiotic Infant mixed with a bit of breastmilk, given by dropper or when baby's old enough, in a bit of water in a zippy cup. IF you use a bottle, of course you can give it that way, in breast milk, formula, or water. Warm wishes! Aviva

Scotti

Aviva,
Thank you for your article (though I'm reading it a little "late"). I am 19 weeks pregnant with #4 and have been begging my husband for a home birth since pregnancy #2.
I was raped at 12 years old and so many of the hospital "standards" here during labor and delivery with #1 brought back feelings and emotions of the rape... from a nurse holding my leg back during pushing to being tethered to the bed from monitors, and from being forced to urinate/defecate with the nursing staff's visual inspection to no control over who enters the room and watches the event. Even the nursing after the delivery was awful; not because of the nurses, but because it's the nature of the beast. Every aspect of the delivery was awful and I had no idea to expect those emotions or feelings. I cried for days after the baby was born, feeling violated and as though I was raped all over again.
Fast forward to baby #2 and I changed OBs. I absolutely LOVE my OB now and have disclosed everything about the rape and delivery #1. Deliveries #2 and #3 weren't much different than #1 except my OB was sure to control who touched my legs (her, DH and myself only), and which hospital staff were in the room (my labor nurse and my OB only). I was minimally monitored after delivery. It became less about me being a patient which I liked.
My husband is scared to death of something going wrong -- blood loss, etc. He likes the comfort of the hospital in case of an emergency. He really is my biggest advocate when we have been there in the past but I'm printing your story to show him... maybe I'll get my homebirth this time with the hard facts in front of him.
Thank you for giving your perspective,
Scotti

Charlie

I feel for you, ma'am. The staff with our first baby was pretty bad too and afterward my wife said she would have rather been raped again because at least then she could have beat the daylights out of the rapist without worrying about potential legal repercussions. Despite being rather picky about her modesty she didn't have PTSD from her past, but she developed a full case of it due to the hospital staff. It was made even worse when a social worker barged into her room and started accusing her of being a child abuser because she had been violated in the past. It took us years to work through the worst of PTSD. I hope you were able to have your third at home like you wished. Our second was born at home and we didn't have the first problem. My wife likes to tease that the emotional trauma she is walking away with this time is being deprived of sleep by a night birth.

Becky C

This was such an awesome read, and such perfect timing for me. My husband and I are expecting our third, and planning our first homebirth. I'm traveling down the winding road toward becoming a midwife. I made the unfortunate mistake of mentioning our homebirth plans to my (now former) primary care physician, who said to me "I guess I just don't understand, if you want to kill your baby, why not just have an abortion now and save yourself the work?" I walked out of the appointment. She called later to apologize, and explained that she was still "raw" from a recent homebirth gone bad that resulted in the death of an infant. I asked her how many babies die during hospital births each year, but naturally she couldn't answer that. It's very frustrating to see two communities so polarized when they should be working together.

aviva

Wow! That's about one of the harshest comments I've ever heard. So sorry you were subjected to that. And there's no excuse from that doctor who really should apologize about 10 more times! But yes, from the medical mindset a home birth gone bad (and that does happen!) seems so inexcusable that it pushes a lot of buttons. But you shouldn't have been subjected to that. :( Aviva

Annelise

This is a great article. I just had my baby two months ago. I received midwife care through the whole pregnancy though in the end I had to be transferred to the hospital and delivered via c-section. I labored for a little over 24 hours at home and we did all we could holistically at home, but in the end I stopped progressing (we later found out what may have stalled the progress, though nothing was absolutely confirmed). Though I was disappointed having to go to the hospital and having both of my worst fears come true, in the end I was glad to have the medical care readily available. I was fortunate enough to have encountered a good, patient and understanding doctor that allowed me the time to ask questions and even try to labor before making his recommendation. However, I know that isn't always the case. Even with such a doctor I immediately felt the push to move things along and the restrictions and invasive care so commonly given. In the end it convinced me that if I had to do it all over again I would choose midwifery care and only go to the hospital when/if absolutely necessary.

BriarRose

So I would like the opinion of mothers, midwives and OBs out there. Would you feel safe with the following mother delivering at home, or in a birth center? 34 yo G10P7 with pmh of a still birth at 32 weeks following hepatitis A and a history of a miscarriage. Otherwise healthy...No history of c-sections.

Brandi

aviva

Hi Brandi,
There is a national birthing center association, and also a group called MANA -- the Midwives Alliance of North America. Both will likely have local listings. Best of luck and so glad you're exploring your options! Warmly, Aviva

Visitor

Are obstetrics practices reliable?
What a question!
Hell yes, they're "reliable!"
Without a primary c/s, I'd have had a dead baby.
I followed up THREE more births with c-sections
and I would not have had it any other way.
My babies were right at my side immediately after birth...
husband still cut the cord...and I was in great hands.
My 'outcomes' would've been quite tragic had I tiptoed
through the narcissistic patch of homebirth.

aviva

Hello,
Thank you for writing, and yes, not all home births are appropriate. But most moms, like you, want the best for their babies and are not choosing home birth because of narcissism. Your experiences do not mean everyone else's would end in tragedy. Few do, in fact. Glad you and your babies are healthy and safe and fantastic that you had such a wonderful experience! ~Aviva

Joelle

I, unfortunately, have experienced the cascade of interventions during my first child's birth. This has led to a total of 5 C-sections. I only wish I would have chosen a homebirth the first time. I'd love to know and evidence-based doctor's opinion on a vaginal birth after five C-sections! Thanks for the wonderful article.

aviva

Ren

I appreciate that you emphasize that the mother needs to be comfortable with her birth setting. My first choice would be home birth, but not in my current living space. So I am reluctantly looking for an OBGYN/midwife for a hospital birth. What are some questions I should ask when looking for one?
By the way, I have 4 children, all were natural births in a hospital. My fourth birth was upsetting, but it was a different hospital and a different practice. I took for granted the experience I had with my first three. So now I have to start over.

JODEE LAMARRE

Thank you for perhaps the most level headed thing I have read today. Thanks for the info, super helpful. Maybe you would be interested in an online service with a ton of Form templates (tax, real estate, legal, business, insurance forms, etc..) I used it to fill out .

Shawna

I considered having this fourth baby at home after three hospital births but have ultimately decided to deliver at the hospital again. Mostly it has to do with wanting that medical team nearby in case they are needed to save my baby, though I am aware of what I will be giving up in exchange. How wonderful would it be if we could have a "home" style delivery in a hospital! But I am determined to stand up and fight for what I want and have chosen a doctor that is willing to mostly go along with what I ask for. :) Only one hospital in my city works with midwifes but I disagree with that particular hospitals standard practice rules and so have chosen a doctor at another hospital. During my last pregnancy, I presented my well thought out and fairly short birth plan and was told "Well, we'll give it to your doctor, but..." Last time with that office!

Martha

Hi aviva I am a master herbalist and have a sister in law who ended up with a c- section after 30 hrs of labor and now she feels confused on what choice to make , whether to try go into labor or just go with a c- section . Her doctor says she and the baby are doing very well, and is also letting her choose what she wants though they do lean more toward a c- section with this second child now. with her first baby she ended up not really breastfeeding since they kept the baby in the hospital for week on the basis that maybe it had a infection . Could you please do an article on a subject like this?? I feel your article are really needed for so many moms. Thanks for any advise you can give .

Megan Liebmann

Ruthann

Thank you for writing this. It's so good and so informative! It's exactly why I decided to have a home birth. I wish more people would do their research before giving birth. It is unbelievable the number of friends I have who, for their first birth, ended up with a c-section or some other intervention. I know the doctors would have pushed extra interventions on me if I had gone to the hospital immediately. I was in labor for three days and barely progressing. I did end up with an epidural but I'm so grateful I started at home. I experienced midwives and the hospital and there is seriously just a different level of care with midwives. Having a birth at the hospital was like walking into a war zone. I felt like I had to defend and fight for everything I wanted from birth. It really is more scary to have a birth at the hospital! Even the pediatricians try to scare you into their fear-based thinking.

Chaya

Hi Aviva,
I have been following you for quite some time and find your wealth of knowledge so refreshing! (I also have ypyr book on pregnancy...so wonderful)
I had two birth in the US and one in The netherlands where we live now. I cannot tell you the difference in the way the Dutch look at birth vs. the general American experience. I was left extremely traumatized by my first birth in NY where I was threatened by my obg that if I did'nt take an epiduralral and pitocin i would have to have a c section! Nevermind that my husband overheared him saying to one of the nurses in the hall that he wanted to hurry me up so he can bill the birth on his shift!!
Giving birth in the Netherlands was a completely different experience. Where unless there is a high risk all women are tended to by midwives and over 40% of woman birth at home.
I am really excited to have another child here coming this August....it is a really beautiful experience!

Wally

Hi Aviva! This was so informative and aligned with what I believe! I would like to have a homebirth (first baby, I'm currently 9 weeks) but my husband is against it. I was wondering if there was a happy medium? Websites with clear facts about the benifits of homebirths that I can direct him to?
We live in NYC and my obgyn recently let me know he doesnt deliver in Manhattan so I'm trying to find a new doctor but not sure how to go about it since I do not want any intervention and am fearful that going to the hospital will be a nightmare as they'll force things. Thank you!! (Sorry for the long story)

Aviva Romm

Sense and Sensibility (Website), Henci Goer's work - are sources I respect.
And of course, HB is standard in CAnada and in many western European countries.
IT's a tough situation because it's such a major decision and your needs have to be prioritized, but his views are important and can influence your comfort and confidence, too. And it's his baby to and there are legit safety concerns with both home and hospital.
But also meeting some midwives who are solid and respected might help him to see things more positively.
Often a birthing center is a happy medium if you can find one you love.
I've heard that Village OB is a more open and relaxed community of docs should you decide on that route.

Aviva Romm

Sense and Sensibility (Website), Henci Goer's work - are sources I respect.
And of course, HB is standard in CAnada and in many western European countries.
IT's a tough situation because it's such a major decision and your needs have to be prioritized, but his views are important and can influence your comfort and confidence, too. And it's his baby to and there are legit safety concerns with both home and hospital.
But also meeting some midwives who are solid and respected might help him to see things more positively.
Often a birthing center is a happy medium if you can find one you love.
I've heard that Village OB is a more open and relaxed community of docs should you decide on that route.
Best wishes!

vikas

hi aviva...what will you prefer if husband blood group is AB+ and wife blood group is B- What precautions has to be taken during and after first pregnancy. and can we have our second child normally hereafter.